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Background: The Behavioural and Cognitive Psychotherapy (BCP) Journal is the main academic publication of the British Association for Behavioural and Cognitive Psychotherapies. It publishes empirical studies, reviews and theoretical papers, brief reports and single cases. Aim: To describe the main areas of interest and focus in BCP papers. Method: All the papers published in BCP from 2000 to July 2016 were analysed. A categorization procedure was followed with 813 contributions in six main areas: main author country; main author gender; kind of contribution; kind of therapeutic approaches; kind of samples; kind of focus/topic. Results: Although the journal's scope is international, first authors tend to come from English-speaking countries. Since 2009, females contribute more than males. Empirical studies surpass theoretical studies and reviews, while the main therapy denomination is cognitive behavioural therapy. Variability of samples is wide, and ranges from analogues to main disorders. Finally, the main focus of papers is to study change and psychopathology, therapists’ training and improvement of CBT. Conclusion: Given the total number of categorized papers, it can be tentatively assumed that they could exemplify some main areas of interest and evolvement in the cognitive and behavioural field. [ABSTRACT FROM AUTHOR]

Background: We compared dissociative seizure specific cognitive behavior therapy (DS-CBT) plus standardized medical care (SMC) to SMC alone in a randomized controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms. Methods: We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland, and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: (a) beliefs about emotions, (b) a measure of avoidance behavior, (c) anxiety and (d) depression. Results: All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures (DS), WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behavior, anxiety, and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behavior. Conclusions: Our findings largely confirmed the logic model underlying the development of CBT for patients with DS. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence to support the use of the psychedelic drug psilocybin for difficult-to-treat depression. This paper compares the cost-effectiveness of psilocybin-assisted psychotherapy (PAP) with conventional medication, cognitive behavioural therapy (CBT), and the combination of conventional medication and CBT. Methods: A decision model simulated patient events (response, remission, and relapse) following treatment. Data on probabilities, costs and quality-adjusted life years (QALYs) were derived from previous studies or from best estimates. Expected healthcare and societal costs and QALYs over a 6-month time period were calculated. Sensitivity analyses were used to address uncertainty in parameter estimates. Results: The expected healthcare cost of PAP varied from £6132 to £7652 depending on the price of psilocybin. This compares to £3528 for conventional medication alone, £4250 for CBT alone, and £4197 for their combination. QALYs were highest for psilocybin (0.310), followed by CBT alone (0.283), conventional medication alone (0.278), and their combination (0.287). Psilocybin was shown to be cost-effective compared to the other therapies when the cost of therapist support was reduced by 50% and the psilocybin price was reduced from its initial value to £400 to £800 per person. From a societal perspective, psilocybin had improved cost-effectiveness compared to a healthcare perspective. Conclusions: Psilocybin has the potential to be a cost-effective therapy for severe depression. This depends on the level of psychological support that is given to patients receiving psilocybin and the price of the drug itself. Further data on long-term outcomes are required to improve the evidence base. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioural therapy (CBT) has, in the space of 50 years, evolved into the dominant modality in psychological therapy. Mechanism/s of change remain unclear, however. Aims: In this paper, we will describe key features of CBT that account for the pace of past and future developments, with a view to identifying candidates for mechanism of change. We also highlight the distinction between 'common elements' and 'mechanisms of change' in psychological treatment. Method: The history of how behaviour therapy and cognitive therapy developed are considered, culminating in the wide range of strategies which now fall under the heading of cognitive behavioural therapy (CBT). We consider how the empirical grounding of CBT has led to the massive proliferation of effective treatment strategies. We then consider the relationship between 'common factors' and 'mechanisms of change', and propose that a particular type of psychological flexibility is the mechanism of change not only in CBT but also effective psychological therapies in general. Conclusion: Good psychological therapies should ultimately involve supporting people experiencing psychological difficulties to understand where and how they have become 'stuck' in terms of factors involved in maintaining distress and impairment. A shared understanding is then evaluated and tested with the intention of empowering and enabling them to respond more flexibly and thereby reclaim their life. [ABSTRACT FROM AUTHOR]

Melanie Fennell's (1997) seminal cognitive approach to low self-esteem was published in Behavioural and Cognitive Psychotherapy. The current paper proposes a refined model, drawing on social theories, and research with people with socially devalued characteristics. This model emphasises how self-esteem relates to perceptions of one's value in the eyes of others. It is proposed that core beliefs typical of low self-esteem relate to one's value in relation to personal adequacy (e.g. having worth or status) and/or to social connection (e.g. being liked, loved, accepted or included). In each of these value domains, beliefs about both the self (e.g. 'I am a failure', 'I am unlovable') and others (e.g. 'Others look down on me', 'Others don't care about me') are considered important. The model suggests that everyone monitors their value but in people with low self-esteem, cognitive biases associated with underlying beliefs occur. In the context of trigger situations, this results in a greater likelihood of negative appraisals of perceived threat to one's value. Such appraisals activate underlying negative beliefs, resulting in negative mood (e.g. low mood, anxiety, shame, disgust) and other responses that maintain low self-esteem. Responses which can be used excessively or in unhelpful ways include (a) corrective behaviours; (b) compensatory strategies; (c) increased value monitoring; (d) safety-seeking behaviours; (e) rumination; (f) unhelpful mood regulation responses. These responses can adversely impact daily functioning or health, having the counterproductive effect of maintaining negative beliefs about one's value. Examples are provided for low self-esteem in lesbian, gay and bisexual individuals. [ABSTRACT FROM AUTHOR]

Since its inclusion in the DSM-III , various theories and treatment approaches have been developed for generalised anxiety disorder (GAD). Aaron T. Beck was the first to offer a cognitive conceptualisation of GAD in Anxiety Disorders and Phobias: A Cognitive Perspective. This original cognitive model of GAD was initially found to be promising in treating GAD but has not been developed further. Other theoretical models and treatments of GAD have gained more research attention, such as the Intolerance of Uncertainty model and Meta-Cognitive model. This article offers a brief overview of multiple theories and treatment approaches of GAD followed by an extensive discussion about the original cognitive model and a revised cognitive model of GAD in the Beckian tradition. Specifically, this paper describes how known key psychological maintenance factors of anxiety disorders, i.e. threat beliefs, safety-seeking behaviours and selective attention, can be used to conceptualise the experience of people with GAD and guide treatment. This is done with theoretical discussion as well as clinical examples. Finally, the paper offers suggestions for key ingredients to be included in cognitive therapy for GAD and future directions for research. Key learning aims: (1) To understand the clinical implications of the original cognitive model and the revised model of generalised anxiety disorder presented here. (2) To understand the role of inflated responsibility for safety, safety-seeking behaviours and elevated evidence requirements in generalised anxiety disorder. (3) To understand and be able to implement treatment recommendations of the revised cognitive model of generalised anxiety disorder. [ABSTRACT FROM AUTHOR]

Training as a cognitive behavioural therapist involves a considerable role transition for mental health professionals where they are expected to demonstrate competence in a range of new skills that emphasise collaboration and Socratic dialogue. This can be in stark contrast to the more didactic style that trainees are familiar with prior to embarking on their training. Guided discovery (GD) is an integral part of formulation and treatment, yet little is known at present about the experiences of cognitive behavioural therapy (CBT) trainees when learning this new skill; specifically, how they assimilate this with existing ways of working and the challenges this might involve. This research is a preliminary attempt to understand factors that help and hinder GD skill acquisition. Eighteen trainee CBT practitioners completed an online questionnaire with the subsequent data analysed using a grounded theory methodology. Three themes were identified: 'Competing Selves', 'Style' and 'Active Engagement and Learning'. These themes were used to develop a preliminary model of factors that enable or inhibit skills in GD. The impact of previous professional roles appears to influence the acquisition of confidence and skill in GD. This paper discusses the implications of the findings for CBT trainers, supervisors and trainees. Key learning aims: As a result of reading this paper, readers should: (1) Understand how trainee cognitive behavioural therapists respond to learning how to use guided discovery. (2) Identify potential barriers to acquiring and improving skills in guided discovery. (3) Recognise training strategies that might assist trainees in becoming more proficient in guided discovery. [ABSTRACT FROM AUTHOR]

In the UK, over three-quarters of a million people cannot speak English well enough to access cognitive behavioural therapy (CBT) in English. If they are to receive an equitable service, they need to be able to access (spoken language) interpreter-mediated therapy. This means that CBT therapists may need support, through training and supervision, to feel confident and positive about incorporating an interpreter into the therapeutic relationship. The requirement for CBT therapists to be able to work effectively with an interpreter is currently acknowledged in the new BABCP minimum training standards and core curriculum, which are recommended for adoption (BABCP, 2021). Understandably, therapists can feel anxious about working with a third person in the room, but when these anxieties are honestly addressed and explored, creative solutions can be found. Therapy is usually conducted in a dyad. A triadic relationship requires attention to the systems at play inside and outside of the therapy room. With careful preparation and planning, interpreter-mediated therapy can be an effective and positive experience for the patient. After an introductory section, the paper is divided into six implementation sections: preparing for interpreter-mediated therapy; meta communication; boundaries; managing three-way relationships; working with interpreters remotely; and support needs of interpreters. Using a case example approach, interpreter-mediated therapeutic situations, which illustrate challenges and solutions, and examples of good practice, are explored. The paper offers practical guidance and illustrations which can form the basis of a training programme which teaches CBT therapists how to form a collaborative working relationship with an interpreter, how a therapist can stay active and maintain their clinical authority in a session in which they do not understand what is being said, and how CBT therapists can ensure that the therapy session remains safe and effective for all three of the participants in the interpreter-mediated encounter. Key learning aims: (1) To help CBT therapists feel more confident and positive about working with spoken language interpreters. (2) To prepare CBT therapists to create a more accessible service for those patients who do not speak sufficient English to engage in therapy without support. (3) To provide CBT therapists with key principles for managing the pulls and pushes in a triadic relationship when you do not understand the language(s) spoken in the room. [ABSTRACT FROM AUTHOR]

Background: As a trainee cognitive therapist in the early 1990s, I was taught the Sh*t Sandwich by my supervisor. 1 continued to use this technique for many years without seeing the need to extend my repertoire of feedback strategies. Aims: This article describes a number of other feedback techniques, raising awareness of the processes underpinning feedback, and facilitating reflection on feedback methods. Method: This review examines feedback and the methods of feedback used to improve clinical competence. Results: Evidence informs us that the use of good feedback has a significant effect on learners' outcomes (Milne, 2009). However, despite recognition of its importance, many supervisors fail to give adequate feedback and utilize methods that are sub-optimal. One such problematic method is the notorious "Sh*t Sandwich" (SS), which attempts to hide criticism within a cushion of two positive statements. This paper looks at various models of giving negative and positive feedback, suggesting that our repertoire of feedback methods may require expanding. Conclusion: The review suggests that feedback is a complex process and methods that place an emphasis on the learner as an active participant in the learning process (i.e. interactive approaches) should be encouraged. The paper suggests that negative feedback should generally be avoided in favour of constructive support, accompanied by specific, descriptive, balanced feedback, with new learning being consolidated by role play. Generally, feedback should be given about the task rather than the person, but when it is personalized it should relate to effort rather than ability. [ABSTRACT FROM AUTHOR]

The article discusses the 50th anniversary of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) and its journal, Behavioural and Cognitive Psychotherapy (BCP). The BABCP was founded 50 years ago as a special interest group and has since become the leading UK organization for cognitive and behavioural psychotherapies. The BCP journal has evolved over the years and now exists as a hybrid online and print publication. The article highlights the diverse range of contributions to the field of cognitive behavioural therapy (CBT) and discusses various topics covered in the journal, including improving access to CBT for children, anger management for adults with intellectual disabilities, and the application of theory to specific disorders. The article also mentions the BABCP's commitment to addressing complex and neglected areas, such as motivational interviewing, psychosis, and prolonged grief. The tCBT journal, a complementary publication, has also focused on under-examined areas and published papers on equity in CBT, cultural adaptation of CBT, and assessing CBT competence. The article concludes by acknowledging the future challenges of CBT and the BABCP's commitment to improving treatment for all groups. [Extracted from the article]

Limited research has directly addressed the challenges of higher education for students with autism, who face additional difficulties in navigating social, personal and academic obstacles. With more students experiencing mental health difficulties whilst at university, therapeutic interventions on offer need to be suitable for those accessing support. Cognitive behavioural therapy (CBT) is widely used to support university students, as it is firmly established as an effective treatment for a range of issues, including social and generalised anxiety in typically developing populations (NICE, 2013; NICE, 2019). However, the efficacy of CBT for individuals with autistic spectrum condition (ASC) is less well known, despite the high prevalence rates of anxiety in this population. This paper seeks to address a gap in the literature and uses a single-case (A-B) experimental design over 16 sessions to reduce co-morbid social and generalised anxiety in a university student with high-functioning ASC. Clark's (2001) cognitive model of social anxiety and Wells' (1997) cognitive model of generalised anxiety were employed to formulate anxiety experienced in this case. Standardised outcome measures were used for social anxiety, i.e. the Social Phobia Inventory (SPIN), and generalised anxiety, i.e. the Generalised Anxiety Disorder-7 (GAD-7), in conjunction with idiographic ratings to assess the impact of therapy. Findings indicate that CBT was an acceptable and useful intervention with mixed results; discrepancies were found between clinical change recorded on standardised measures compared with idiographic ratings. This paper discusses the use of standardised measures of anxiety for individuals with ASC and identifies directions for further research. Key learning aims: (1) To appreciate the unique mental health challenges of university students with ASC. (2) To identify psychological interventions that are suitable for individuals with ASC. (3) To consider the value in employing more than one evidence-based cognitive model of anxiety when clients present with co-morbid mental health issues. (4) To question the utility of using standardised outcome measures compared with idiographic measures in therapy. [ABSTRACT FROM AUTHOR]

Background: Delusional infestation is a condition at the interface of tactile and visual hallucinations and delusions. Individuals with this condition hold the fixed and false belief that their body or their environment is infested with parasites, insects or other organisms. Aims: There are no guidelines or publications detailing the psychological assessment, formulation, intervention and evaluation of this presentation. This paper aims to address this gap. Method: Single case experimental design methodology was employed to evaluate the use of cognitive behavioural therapy (CBT) for delusional infestation in a 70-year-old male who was intolerant of anti-psychotic medication. 'Tom' had a large, mature infarct in the middle cerebral artery territory as well as a left posterior parietal infarct post-stroke, which may have precipitated his symptoms. After a baseline period of 3 weeks, Tom received eight sessions of CBT based on the model by Collerton and Dudley (2004). Results: Post-intervention, there was a reliable improvement on clinical measures as well as a large reduction in distress levels, which was maintained at 3-month follow-up. The conviction in the belief that the infestation was real did not shift. Conclusion: This case demonstrated the potential for the use of CBT to address distress related to delusional infestation. This work is discussed in relation to post-stroke psychosis, psychological therapies with older adults, and suggestions are made for future research. [ABSTRACT FROM AUTHOR]

There has been an explosion of interest in mindfulness-based programs (MBPs) such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy. This is demonstrated in increased research, implementation of MBPs in healthcare, educational, criminal justice and workplace settings, and in mainstream interest. For the sustainable development of the field there is a need to articulate a definition of what an MBP is and what it is not. This paper provides a framework to define the essential characteristics of the family of MBPs originating from the parent program MBSR, and the processes which inform adaptations of MBPs for different populations or contexts. The framework addresses the essential characteristics of the program and of teacher. MBPs: are informed by theories and practices that draw from a confluence of contemplative traditions, science, and the major disciplines of medicine, psychology and education; underpinned by a model of human experience which addresses the causes of human distress and the pathways to relieving it; develop a new relationship with experience characterized by present moment focus, decentering and an approach orientation; catalyze the development of qualities such as joy, compassion, wisdom, equanimity and greater attentional, emotional and behavioral self-regulation, and engage participants in a sustained intensive training in mindfulness meditation practice, in an experiential inquiry-based learning process and in exercises to develop understanding. The paper's aim is to support clarity, which will in turn support the systematic development of MBP research, and the integrity of the field during the process of implementation in the mainstream. [ABSTRACT FROM PUBLISHER]

Background: Health anxiety (HA), or hypochondriasis, is a psychological problem characterized by a preoccupation with the belief that one is physically unwell. A 2007 Cochrane review (Thomson and Page, 2007) found cognitive behavioural therapy (CBT) to be an effective intervention for individuals with HA. Similar findings were reported in a recent meta-analysis (Olatunji et al., 2014), which did not employ a systematic search strategy. The current review aimed to investigate the efficacy of CBT for HA, and to update the existing reviews. Method: A systematic search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, including randomized controlled trials that compared CBT with a control condition for people with HA. Five hundred and sixty-seven studies were found in the original search, of which 14 were included in the meta-analysis. Results: Meta-analysis was conducted on 21 comparisons and a large effect size for CBT compared with a control condition was found at post therapy d = 1.01 (95% confidence interval 0.77–1.25), as well as at 6- and 12-month follow-up. Conclusions: This systematic review and meta-analysis provides support for the hypothesis that CBT is an effective intervention for HA when compared with a variety of control conditions, e.g. treatment-as-usual, waiting list, medication, and other psychological therapies. [ABSTRACT FROM PUBLISHER]

Aims: Refugees are confronted with the task of adapting to the long-term erosion of psychosocial systems and institutions that in stable societies support psychological well-being and mental health. We provide an overview of the theoretical principles and practical steps taken to develop a novel psychotherapeutic approach, Integrative Adapt Therapy (IAT), which aims to assist refugees to adapt to these changes. This paper offers the background informing ongoing trials of IAT amongst refugees from Myanmar. Methods: A systematic process was followed in formulating the therapy and devising a treatment manual consistent with the principles of the Adaptation and Development After Persecution and Trauma (ADAPT) model. The process of development and refinement was based on qualitative research amongst 70 refugees (ten from West Papua and 60 Rohingya from Myanmar). The therapeutic process was then piloted by trained interventionists amongst a purposively selected sample of 20 Rohingya refugees in Malaysia. Results: The final formulation of IAT represented an integration of the principles of the ADAPT model and evidence-based techniques of modern therapies in the field, including a transdiagnostic approach and the selective use of cognitive behavioural treatment elements such as problem-solving and emotional regulation techniques. The steps outlined in refining the manual are outlined in relation to work amongst West Papuan refugees, and the process of cultural and contextual modifications described during early piloting with Rohingya refugees in Malaysia. Conclusions: IAT integrates universal principles of the ADAPT model with the particularities of the culture, history of conflict and living context of each refugee community; this synthesis of knowledge forms the basis for participants gaining insights into their personal patterns of psychosocial adaptation to the refugee experience. Participants then apply evidence-based techniques to improve their capacity to adapt to the serial psychosocial changes they have encountered in their lives as refugees. The overarching goal of IAT is to provide refugees with a coherent framework that assists in making sense of their experiences and their emotional and interpersonal reactions to the challenges they confront within the family and community context. As such, the principles of a general model (ADAPT) are used as a springboard for making concrete, manageable and meaningful life changes at the individual level, a potentially novel approach for psychosocial interventions in the field. [ABSTRACT FROM AUTHOR]

Action-based methods such as behavioural experiments, role-play and (by extension) 'chairwork' are powerful techniques recommended in core supervisory texts for cognitive behavioural therapy (CBT). Despite this, experiential methods are seldom used by supervisors, suggesting that supervision often drifts from a 'doing process' to a 'talking process'. A number of factors contribute to this divergence from best practice, including limited confidence and a lack of familiarity with experiential procedures amongst supervisors. To address this, the current paper presents a variety of action-based techniques for enhancing supervisees' technical, perceptual, interpersonal, reflective and personal competencies. Behavioural experiments, empty-chair, multi-chair and role-playing exercises for maintaining treatment fidelity, enhancing empathic attunement, repairing therapeutic ruptures, resolving impasses and working through negative countertransference are described, amongst others. Further research is needed to establish the nature and extent of supervisory drift, as well as the efficacy of action-based methods. Key learning aims: As a result of reading this paper, readers should: (1) Understand why supervision sometimes drifts from being a 'doing' process. (2) Appreciate the value of experiential, action-based supervisory methods. (3) Feel competent using action-based methods to enhance supervisees' clinical skills. [ABSTRACT FROM AUTHOR]

Background: The SUPEREDEN3 study, a phase II randomized controlled trial, suggests that social recovery therapy (SRT) is useful in improving functional outcomes in people with first episode psychosis. SRT incorporates cognitive behavioural therapy (CBT) techniques with case management and employment support, and therefore has a different emphasis to traditional CBT for psychosis, requiring a new adherence tool. Aims: This paper describes the SRT adherence checklist and content of the therapy delivered in the SUPEREDEN3 trial, outlining the frequency of SRT techniques and proportion of participants who received a full therapy dose. It was hypothesized that behavioural techniques would be used frequently, consistent with the behavioural emphasis of SRT. Method: Research therapists completed an adherence checklist after each therapy session, endorsing elements of SRT present. Data from 1236 therapy sessions were reviewed to determine whether participants received full, partial or no therapy dose. Results: Of the 75 participants randomized to receive SRT, 57.3% received a full dose, 24% a partial dose, and 18.7% received no dose. Behavioural techniques were endorsed in 50.5% of sessions, with cognitive techniques endorsed in 34.9% of sessions. Conclusions: This report describes an adherence checklist which should be used when delivering SRT in both research and clinical practice. As hypothesized, behavioural techniques were a prominent feature of the SRT delivered in SUPEREDEN3, consistent with the behavioural emphasis of the approach. The use of this adherence tool would be considered essential for anyone delivering SRT looking to ensure adherence to the model. [ABSTRACT FROM AUTHOR]

AbstractThere is a lot of nonsense talked about how to adapt therapy for older people. This is because often authors fail to define the types of populations they are tailoring their therapy for. Such definitions are important with such a diverse patient group, some of whom were ?in-service? during the first world war, while others were ?doing drugs and dropping out? in the 1960s. To guide our thinking regarding specific adaptations, this paper presents a framework for clarifying therapeutic need. The second section of the paper illustrates ways in which working psychotherapeutically with older patients has helped inform mainstream CBT theory and practice, with particular reference to competence and schema work. [ABSTRACT FROM AUTHOR]

The subject of prolonged, complicated and traumatic grief has become more topical as a consequence of the Covid-19 pandemic. CBT practitioners have been asked to provide effective therapeutic responses for clients with enduring distressing grief reactions. These enduring grief conditions have now been categorised as Prolonged Grief Disorder in the two main mental health classification systems: in the ICD -11 in November 2020 and as a revision to the DSM-5 in 2021. In this paper we draw on our research and clinical experience in applying cognitive therapy for PTSD (CT-PTSD) to traumatic bereavement to derive lessons for the treatment of prolonged grief. During the pandemic the authors of this paper delivered several workshops on prolonged grief disorder (PGD) during which clinicians raised several thought-provoking questions; how do we differentiate between normal and abnormal or pathological grief; how do we categorise pathological grief; how effective are existing therapies and is there a role for CBT; and how do our experiences with Cognitive Therapy for PTSD help with conceptualisation and treatment of PGD. The purpose of this paper is to answer these important questions and in so doing, consider the historical and theoretical concepts relating to complex and traumatic grief, factors that differentiate normal grief from abnormal grief, maintenance factors for PGD and implications for CBT treatments. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) after traumatic birth can have a debilitating effect on parents already adapting to significant life changes during the post-partum period. Cognitive therapy for PTSD (CT-PTSD) is a highly effective psychological therapy for PTSD which is recommended in the NICE guidelines (National Institute for Health and Care Excellence, 2018) as a first-line intervention for PTSD. In this paper, we provide guidance on how to deliver CT-PTSD for birth-related trauma and baby loss and how to address common cognitive themes. Key learning aims: (1) To recognise and understand the development of PTSD following childbirth and baby loss. (2) To understand how Ehlers and Clark's (2000) cognitive model of PTSD can be applied to post-partum PTSD. (3) To be able to apply cognitive therapy for PTSD to patients with perinatal PTSD, including traumatic baby loss through miscarriage or birth. (4) To discover common personal meanings associated with birth trauma and baby loss and the steps to update them. [ABSTRACT FROM AUTHOR]

Traumatic loss is associated with high rates of post-traumatic stress disorder (PTSD) and appears to inhibit the natural process of grieving, meaning that patients who develop PTSD after loss trauma are also at risk of experiencing enduring grief. Here we present how to treat PTSD arising from traumatic bereavement with cognitive therapy (CT-PTSD; Ehlers et al., 2005). The paper describes the core components of CT-PTSD for bereavement trauma with illustrative examples, and clarifies how the therapy differs from treating PTSD associated with trauma where there is no loss of a significant other. A core aim of the treatment is to help the patient to shift their focus from loss to what has not been lost, from a focus on their loved one being gone to considering how they may take their loved one forward in an abstract, meaningful way to achieve a sense of continuity in the present with what has been lost in the past. This is often achieved with imagery transformation, a significant component of the memory updating procedure in CT-PTSD for bereavement trauma. We also consider how to approach complexities, such as suicide trauma, loss of a loved one in a conflicted relationship, pregnancy loss and loss of life caused by the patient. Key learning aims: (1) To be able to apply Ehlers and Clark's (2000) cognitive model to PTSD arising from bereavement trauma. (2) To recognise how the core treatment components differ for PTSD associated with traumatic bereavement than for PTSD linked to trauma where there is no loss of life. (3) To discover how to conduct imagery transformation for the memory updating procedure in CT-PTSD for loss trauma. [ABSTRACT FROM AUTHOR]

Background: There is increasing interest in the provision of cognitive behaviour therapy (CBT) to people with intellectual disabilities. A small number of studies have begun to address therapy process issues. Aims: The aim of this paper is to contribute to process research through the development of a taxonomy of question types for use in analysing therapy interactions in CBT for people with intellectual disabilities. Method: A taxonomy of CBT question types was adapted and applied to the transcriptions of session 4 and 9 of 15 CBT therapy dyads. Results: The taxonomy was reliably applied to the data. Therapists used significantly more questions in session 4 than in session 9, therapists used fewer questions in the final quarter of all sessions, and therapists used more questions with people with higher IQ scores in session 4 but not in session 9. Conclusions: The taxonomy of questions is reliable and may be used in future studies of CBT therapy process with people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Population ageing and the global burden of dementia pose a major challenge for human societies and a priority for public health. Cognitive enhancement, i.e. the targeted amplification of core cognitive abilities, is raising increasing attention among researchers as an effective strategy to complement traditional therapeutic and assistive approaches, and reduce the impact of age-related cognitive disability. In this paper, we discuss the possible applicability of cognitive enhancement for public health purposes to mitigate the burden of population ageing and dementia. After discussing the promises and challenges associated with enhancing ageing citizens and people with cognitive disabilities, we argue that global societies have a moral obligation to consider the careful use of cognitive enhancement technologies as a possible strategy to improve individual and public health. In addition, we address a few primary normative issues and possible objections that could arise from the implementation of public health-oriented cognitive enhancement technologies. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioural therapy (CBT) is an effective psychological treatment for major depressive disorder, although some patients experience a return of symptoms after finishing therapy. The ability to predict which individuals are more vulnerable to deterioration would allow for targeted interventions to prevent short-term relapse and longer-term recurrence. Aim: This systematic review and meta-analysis aimed to identify factors associated with an increased risk of relapse and/or recurrence (RR) after CBT for depression. Method: We reviewed 13 relevant papers, of which a small set of unique samples were eligible for meta-analysis (k = 5, N = 369). Twenty-six predictor variables were identified and grouped into seven categories: residual depressive symptoms; prior episodes of depression; cognitive reactivity; stressful life events; personality factors; clinical and diagnostic factors; demographics. Results: Meta-analyses indicated that residual depressive symptoms (r = 0.34 [0.10, 0.54], p =.01) and prior episodes (r = 0.19 [0.07, 0.30], p =.002) were statistically significant predictors of RR, but cognitive reactivity was not (r = 0.18 [−0.02, 0.36], p =.08). Other variables lacked replicated findings. On average, 33.4% of patients experienced RR after CBT. Conclusions: Patients with the above risk factors could be offered evidence-based continuation-phase interventions to enhance the longer-term effectiveness of CBT. [ABSTRACT FROM AUTHOR]

Cognitive behavioural therapy (CBT) in its current form might not be acceptable to service users from a variety of backgrounds. Therefore, it makes sense to adapt CBT when working with diverse populations. Contributors to this special issue of the Cognitive Behaviour Therapist have tackled the issues around the cultural adaptation of CBT from various perspectives, using a variety of methods, and have addressed topics ranging from cultural adaptation to improving access to CBT. Here, I briefly summarize and discuss the papers in this special issue. I start with a systematic review of CBT for social anxiety across cultures. Seven articles cover aspects of adaptation of therapies for people from different backgrounds. Three papers discuss the issues of gender and sexuality when using CBT, while another three papers focus on refugees, asylum seekers and the homeless, and two papers describe the application of CBT with religious populations. Finally, there are seven papers on issues related to service delivery, practice and training and supervision when working with a diverse population. Collectively, papers in this special issue provide us with sufficient evidence that cultural considerations play a vital role when using CBT, offer practical suggestions for improving cultural competence and most importantly, can catalyse future research. However, the full potential of culturally adapted interventions will not be realized until and unless access to CBT is improved. Therefore, there is a need to build robust evidence to convince funders, policy makers and service managers. [ABSTRACT FROM AUTHOR]

Cognitive behaviour therapy (CBT) as a treatment for schizophrenia and psychotic-related disorders has been shown to have significantly greater drop-out rates in clients of black and minority ethnic (BME) groups. This has resulted in poor outcomes in treatments. Our recent qualitative study thus aimed to develop culturally sensitive CBT for BME clients. The study consisted of individual in-depth 1:1 interviews with patients with a diagnosis of schizophrenia, schizo-affective, delusional disorders or psychosis (n = 15) and focus groups with lay members (n = 52), CBT therapists (n = 22) and mental health practitioners (n = 25) on a data set of 114 participants. Several themes emerged relating to therapist awareness on culturally derived behaviours, beliefs and attitudes that can influence client response and participation in therapy. The current paper aims to explore one of these themes in greater detail, i.e. client-initiated therapist self-disclosure (TSD). Using thematic analysis, the paper highlights key elements of TSD and how this could impact on therapist's reactions towards TSD, the therapeutic alliance and ultimately, the outcomes of therapy. The findings appear to show that TSD has significant relevance in psychological practice today. Some BME client groups appear to test therapists through initiating TSD. It is not the content of TSD they are testing per se, but how the therapist responds. Consequently, this requires therapists' cognisance and sensitive responses in a manner that will nurture trust and promote rapport. Further investigation in this area is suggested with a recommendation for guidelines to be created for clinicians and training. Key learning aims: (1) To develop a dialogue and practice with confidence when addressing issues of self-disclosure with diverse populations. (2) To appreciate the impact therapist self-disclosure has in early stages of engagement, in particular when working with patients from BME communities. (3) To understand the impact and role of self-disclosure as initiated by patients. (4) To increase therapist awareness on cultural differences in self-disclosure and develop ways to address this in therapy. (5) To challenge therapists to adapt psychological therapies to diverse cultures and be cognisant that 'one size does not fit all'. [ABSTRACT FROM AUTHOR]

There is a very high prevalence of post-traumatic stress disorder (PTSD) within refugee populations and survivors of torture. Refugees, asylum seekers and survivors of torture who access IAPT (Improving Access to Psychological Therapies) can present with unique clinical challenges for cognitive behavioural therapy (CBT) therapists. The use of reflective practice can be beneficial particularly when there is added complexity in the client's clinical presentation. The aim of this paper is to provide an overview of how reflective practice can improve clinical work with this patient group and to identify some of the challenges that refugees, asylum seekers and survivors of torture may present with during therapy. The paper sets out how the use of the critical incident analysis model and clinical supervision can assist to develop reflective practice skills and improve the clinical practice of IAPT CBT therapists who work with diverse populations. [ABSTRACT FROM AUTHOR]

Background.E-mental health is a growing research field and an increasing number of computerized cognitive behavior therapy (cCBT) interventions are available for numerous mental health issues. Such interventions are often claimed to have added benefits, or collateral outcomes, when compared with traditional delivery platforms. Our aim was to systematically review the evidence of the cost-effectiveness, geographic flexibility, time flexibility, waiting time for treatment, stigma, therapist time, effects on help-seeking and treatment satisfaction of cCBT interventions for mental health.Method.The electronic databases Medline and Web of Science were searched for peer-reviewed controlled trials investigating collateral outcomes in computerized and internet-based CBT.Results.The literature search identified 101 published papers (95 studies), which were included in this review. The results suggest that cCBT interventions are cost-effective and often cheaper than usual care. Limited evidence was found with regard to geographic flexibility, time flexibility, waiting time for treatment, stigma and the effects on help-seeking. Personal support in cCBT was found to take many forms, was not limited only to therapists, and seemed to increase treatment adherence and reduce attrition. Treatment satisfaction with cCBT was found to be high, but more research on attrition due to dissatisfaction is required.Conclusions.Although the results of this systematic review on the collateral outcomes provide support for the potential of cCBT, these outcomes need to be better assessed within individual e-mental health studies. [ABSTRACT FROM AUTHOR]

Background: Different theories concerning pathways to insight have been proposed which underpin the numerous assessment measures. Cognitive behavioural therapy (CBT) is one treatment approach that has been used to improve insight. Aims: The aim of this review was to promote a greater focus on developing effective CBT strategies to ameliorate insight in psychosis through the exploration of the concept of insight in psychosis and evaluation of research in the area. Method: A comprehensive search and review of published studies examining the impact of CBT on insight in psychosis was conducted. We searched the databases PubMed, Medline, PsychInfo, the Psychology and Behavioral Sciences Database, and CINAHL with limits set to 10 years, humans, and English language. We hand-searched reference lists of major studies on insight, and theoretical review papers. We filtered our results according to relevance and chose 50 papers for final consideration. Results: The multidimensionality of insight is reflected in the variety of different insight measures in clinical use. Research findings on the impact of CBT on insight are conflicting. Cognitive insight and clinical insight appear to be different concepts that are not fully captured by existing measurement scales. Conclusions: The conflicting results found in research examining the impact of CBT on insight may be partially explained by the different theories underpinning insight in psychosis communicated through psychoeducation in CBT. Furthermore, the use of more than one insight assessment measure may capture the complexity of insight more effectively. Qualitative research with service users would enrich the knowledge in this area. [ABSTRACT FROM AUTHOR]

Some more recent lines of research converge on claiming that human cognitive behavior in general and linguistic discourse in particular cannot reasonably be reduced to one monolithic system of cognitive activity. What this research suggests, rather, is that this behavior exhibits a dualistic organization. In the present paper, two frameworks representing this tradition are contrasted, namely Discourse Grammar and the dual process model. The former rests on observations on language structure and language use, while the latter was developed on the basis of neurolinguistic observations. The two frameworks converge on claiming that there is a significant correlation between linguistic categorization and hemisphere-based brain activity. The present paper argues that this correlation can be related to contrasting linguistic functions associated with each of the two hemispheres. [ABSTRACT FROM AUTHOR]

Introduction: Burn-out syndrome is an underestimated entity in the medical environment, and lack of health policies for screening, prevention and early phase treatment strategies may be responsable for complications of this syndrome, e.g. major depression, substance use disorders, or anxiety disorders. Large variations in the estimation of burn-out prevalence in healthcare providers may be related to poorly designed epidemiological trials and lack of welldefined criteria for diagnosis. Objectives: To analyse the current evidence in the literature about the diagnosis and treatment of burn-out syndrome in physicians and auxiliary personnel. Methods: A literature review was performed through the main medical databases (Cochrane Database of Systematic reviews, PubMed, Thomson Reuters/Web of Science, SCOPUS, EMBASE, CINAHL) using the search paradigm "burn-out" AND "healthcare providers" OR "physicians" AND "nurses". All papers published between January 2000 and August 2020 were included in the primary analysis. Results: A large number of papers were detected in the primary analysis (n=245), but only 15 remained after the inclusion/exclusion criteria were applied. Maslach Inventory for Burnout is the most extensively used instrument for screening, but its validity is questioned, and new instruments have been created, but less frequently applied. Cognitive behavioral therapy led to improvement of the emotional exhaustion in multiple trials. Meditation techniques, music therapy, structured physical exercises, and management-related interventions have been associated with low to moderate degree of success. Conclusions: Burn-out syndrome is a still insufficiently explored diagnosis and more good-quality epidemiological and clinical trials are needed in order to support adequate prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Music has the potential to be an effective and engaging therapeutic intervention in the treatment of mental illness. This research area remains underdeveloped. Aims: This paper reports the feasibility of an innovative low-intensity CBT-based music (CBT-Music) group targeted to symptoms of depression and anxiety. Method: A total of 28 participants with symptoms of depression and anxiety who were attending community mental health services were recruited for the study and randomized into TAU (treatment as usual) plus low-intensity CBT-Music (treatment) or to TAU alone (control). The treatment group consisted of a 9-week music group that incorporated various components of CBT material into a musical context. Feasibility was the primary outcome. The secondary outcomes were a reduction in depression, anxiety (Hospital Anxiety and Depression Scale) and disability (WHO Disability Assessment Schedule 2.0) assessed at baseline and 10 weeks. Results: Recruitment proved feasible, retention rates were high, and the participants reported a high level of acceptability. A randomized control study design was successfully implemented as there were no significant differences between treatment and control groups at baseline. Participants in the treatment group showed improvement in disability (p = 0.027). Despite a reduction in depression and anxiety scores, these differences were not statistically significant. Conclusions: A low-intensity CBT-based music group can be successfully administered to clients of community mental health services. There are indications of effectiveness in reducing disability, although there appears to be negligible effect on symptoms of anxiety and depression. This is the first report of a trial of a low-intensity CBT-based music group intervention. [ABSTRACT FROM AUTHOR]

Health anxiety is an important new diagnosis that is increasing in frequency because of changing attitudes towards health, particularly excessive use of health information on the internet (cyberchondria). People with abnormal health anxiety become over-diligent monitors of their health, misinterpret most somatic sensations as evidence of disease, consult medical professionals unnecessarily and frequently, and are often over-investigated. Relatively few patients with health anxiety present to psychiatrists; most are seen in primary and secondary medical care. This paper reviews the diagnosis and presenting features of health anxiety, its identification in practice and its treatment. A range of simple psychological treatments have been shown to have long-lasting benefit for the disorder but are greatly under-used. [ABSTRACT FROM AUTHOR]

Aims and method This is a longitudinal cohort study describing the demand, capacity and outcomes of adult specialist eating disorder in-patient services covering a population of 3.5 million in a South-East England provider collaborative before and since the COVID-19 pandemic, between July 2018 and March 2021. Results There were 351 referrals for admission; 97% were female, 95% had a diagnosis of anorexia nervosa and 19% had a body mass index (BMI) <13. Referrals have increased by 21% since the start of pandemic, coinciding with reduced capacity. Waiting times have increased from 33 to 46 days. There were significant differences in outcomes between providers. A novel, integrated enhanced cognitive behaviour theapy treatment model showed a 25% reduction in length of stay and improved BMI on discharge (50% v. 16% BMI >19), compared with traditional eclectic in-patient treatment. Clinical implications Integrated enhanced cognitive behaviour theapy reduced length of stay and improved outcomes, and can offer more effective use of healthcare resources. [ABSTRACT FROM AUTHOR]

Recent reviews and meta-analyses of metacognitive therapy for schizophrenia-spectrum disorder (SSD) have included uncontrolled studies, single-session interventions, and/or analyses limited to a single form of metacognitive therapy. We sought to evaluate the efficacy of metacognitive therapies more broadly based on controlled trials (CT) of sustained treatments. We conducted a pre-registered meta-analysis of controlled trials that investigated the effects of meta-cognitive therapies on primary positive symptom outcomes, and secondary symptom, function and/or insight measures. Electronic databases were searched up to March 2022 using variants of the keywords, 'metacognitive therapy', 'schizophrenia', and 'controlled trial'. Studies were identified and screened according to PRISMA guidelines. Outcomes were assessed with random effects models and sample, intervention, and study quality indices were investigated as potential moderators. Our search identified 44 unique CTs with usable data from 2423 participants. Data were extracted by four investigators with reliability >98%. Results revealed that metacognitive therapies produced significant small-to-moderate effects on delusions (g = 0.32), positive symptoms (g = 0.30) and psychosocial function (g = 0.31), and significant, small effects on cognitive bias (g = 0.25), negative symptoms (g = 0.24), clinical insight (g = 0.29), and social cognition (g = 0.27). Findings were robust in the face of sample differences in age, education, gender, antipsychotic dosage, and duration of illness. Except for social cognition and negative symptoms, effects were evident even in the most rigorous study designs. Thus, results suggest that metacognitive therapies for SSD benefit people, and these benefits transfer to function and illness insight. Future research should modify existing treatments to increase the magnitude of treatment benefits. [ABSTRACT FROM AUTHOR]

Background: To evaluate the clinical efficacy of COMPASS, a therapist-supported digital therapeutic for reducing psychological distress (anxiety/depression) in people living with long-term physical health conditions (LTCs). Methods: A two-armed randomized-controlled trial recruiting from LTC charities. Participants with anxiety and/or depression symptoms related to their LTC(s) were randomized (concealed allocation via independent administrator) to COMPASS (access to 11 tailored modules plus five thirty-minute therapist support sessions) or standard charity support (SCS). Assessments were completed online pre-randomization, at 6- and 12-weeks post-randomization. Primary outcome was Patient Health Questionnaire Anxiety and Depression Scale; PHQ-ADS measured at 12-weeks. Analysis used intention-to-treat principles with adjusted mean differences estimated using linear mixed-effects models. Data-analyst was blinded to group allocation. Results: 194 participants were randomized to COMPASS (N = 94) or SCS (N = 100). At 12-weeks, mean level of psychological distress was 6.82 (95% confidence interval; CI 4.55–9.10) points lower (p < 0.001) in the COMPASS arm compared with SCS (standardized mean difference of 0.71 (95% CI 0.48–0.95)). The COMPASS arm also showed moderate significant treatment effects on secondary outcomes including depression, anxiety and illness-related distress and small significant effects on functioning and quality-of-life. Rates of adverse events were comparable across the arms. Deterioration in distress at 12-weeks was observed in 2.2% of the SCS arm, and no participants in the COMPASS arm. Conclusion: Compared with SCS, COMPASS digital therapeutic with minimal therapist input reduces psychological distress at post-treatment (12-weeks). COMPASS offers a potentially scalable implementation model for health services but its translation to these contexts needs further evaluating. Trial Registration: NCT04535778 [ABSTRACT FROM AUTHOR]

Background: This systematic review and individual participant data meta-analysis (IPDMA) examined the overall effectiveness of eye movement desensitization and reprocessing (EMDR) in reducing posttraumatic stress disorder (PTSD) symptoms, achieving response and remission, and reducing treatment dropout among adults with PTSD compared to other psychological treatments. Additionally, we examined available participant-level moderators of the efficacy of EMDR. Methods: This study included randomized controlled trials. Eligible studies were identified by a systematic search in PubMed, Embase, PsyclNFO, PTSDpubs, and CENTRAL. The target population was adults with above-threshold baseline PTSD symptoms. Trials were eligible if at least 70% of study participants had been diagnosed with PTSD using a structured clinical interview. Primary outcomes included PTSD symptom severity, treatment response, and PTSD remission. Treatment dropout was a secondary outcome. The systematic search retrieved 15 eligible randomized controlled trials (RCTs); 8 of these 15 were able to be included in this IPDMA (346 patients). Comparator treatments included relaxation therapy, emotional freedom technique, trauma-focused cognitive behavioral psychotherapies, and REM-desensitization. Results: One-stage IPDMA found no significant difference between EMDR and other psychological treatments in reducing PTSD symptom severity (β = −0.24), achieving response (β = 0.86), attaining remission (β = 1.05), or reducing treatment dropout rates (β = −0.25). Moderator analyses found unemployed participants receiving EMDR had higher PTSD symptom severity at the post-test, and males were more likely to drop out of EMDR treatment than females. Conclusion: The current study found no significant difference between EMDR and other psychological treatments. We found some indication of the moderating effects of gender and employment status. [ABSTRACT FROM AUTHOR]

Background: There has been a recent focus on the interpersonal nature of the voice hearing experience, with studies showing that similar patterns of relating exist between voice hearer and voice as between voice hearer and social others. Two recent therapeutic approaches to voices, Cognitive Therapy for Command Hallucinations and Relating Therapy, have been developed to address patterns of relating and power imbalances between voice hearer and voice. Aims: This paper presents a novel intervention that combines elements of these two therapies, named Cognitive Behavioural Relating Therapy (CBRT). Method: The application of CBRT is illustrated through a clinical case study. Results: The clinical case study showed changes in patterns of relating, improved self-esteem and reductions in voice-related distress. Conclusions: The outcomes provide preliminary support for the utility of CBRT when working with voice hearers. [ABSTRACT FROM AUTHOR]

Background: This paper looks at attrition in relation to deprivation and type of therapy – CBT or person-centred counselling. Method: Case notes of all those referred in a 4-month period (n = 497) were assessed for those who failed to opt-in; those who opted-in but failed to attend first appointment and those who attended first appointment but subsequently dropped-out. Results: Significant numbers failed to opt-in, attend first appointment or dropped out during therapy. There were no differences between CBT and PCT. Those from the most deprived areas were less likely to opt-in. Conclusions: We need to develop better approaches to attracting and maintaining contact with individuals complaining of common mental health problems. [ABSTRACT FROM PUBLISHER]

Questions underpin all aspects of therapeutic assessment and intervention and are a vital component of the clinical process. Over recent years frameworks have started to be applied to obtain a greater understanding of questioning formats and processes. Method: This paper examines the use of questions in cognitive therapy (CT). An overview of the main types of questions identified in the literature is presented. In addition, we examine a range of client and therapist characteristics that may impact on the questioning process. Conclusions: Asking questions in therapy is a complex, yet under-taught, skill. This paper provides a set of frameworks to assist in identifying helpful and unhelpful questioning skills. Thus the article has implications for further training and research. [ABSTRACT FROM AUTHOR]

Background:The present paper describes the cognitive-behavioural approach evolved and adapted to treat survivors of the London bombings experiencing fear and avoidance of public transport (travel phobia). Method: Treatment outcomes for a consecutive case series (N= 11) are reported. Results: All individuals who completed treatment (N= 10) had returned to their pre-bombing use of transport and reported minimal symptoms. Conclusions:The need for appropriately tailored treatment based on differential diagnosis and formulation and the importance of incorporating skills for treatment of posttraumatic stress disorder are discussed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

Digital CBT refers to the use of digital tools, platforms or devices to deliver or enhance cognitive behavioural therapy assessment, formulation, treatment, training and supervision. The 'Advances in Digital CBT' special issue aimed to document examples of innovative digital CBT practice in this rapidly developing field. In this paper, we have briefly summarised and synthesised the advances demonstrated in this group of articles. These include developments in our understanding of mental health apps, the use of digital tools as an adjunct to therapy, the effectiveness of remotely delivered CBT in routine clinical practice, our understanding of user experiences and involvement, and in digital CBT research methods. We consider the extent of current knowledge in these areas and identify where gaps in evidence lie and how the field could be taken forward to address these. Lastly, we reflect on the broader digital CBT picture and offer our suggestions of six key directions for future research: using robust study designs to evaluate and optimise digital tools; translating and culturally adapting digital tools and practices; understanding and addressing digital exclusion; exploring, reporting and addressing possible negative effects; improving user involvement in design and evaluation; and addressing the implementation gap for digital tools. We suggest that further advances in these areas would be of particular benefit to the digital CBT field. Key learning aims: (1) To gain an overview of the articles in the special issue and an understanding of the advances in digital CBT they represent. (2) To understand how the advances suggested by the present studies could be taken forward and extended. (3) To consider key future directions for further advances in digital CBT. [ABSTRACT FROM AUTHOR]

Internet-delivered cognitive behaviour therapy (ICBT) is effective for treating anxiety and depression among post-secondary students, although outcomes are modest. Booster lessons have been proposed for maintaining and improving outcomes but have not been investigated following ICBT for students. This study used a mixed-methods approach to examine student (N = 146) use of a self-guided booster lesson offered 1 month after a 5-week ICBT course, whereby the booster lesson provided a review of ICBT skills and suggestions for maintaining motivation and problem solving. A survey about the booster was administered shortly after the booster to understand student preferences for the booster lessons, reasons for completing/not completing the booster, and satisfaction with the booster. Approximately one-third of students (n = 47) utilized the booster lesson. Completing a greater number of lessons during the main ICBT course was associated with uptake of the booster. The booster survey was completed by 20 of the 47 (∼43%) students who completed the booster lesson and 42 of the 99 who did not (∼42%). Students varied in perceptions of the ideal timing of the booster (1–2 weeks to 3–6 months) and approximately 60% expressed preference for completing the booster independently. Among non-completers of the booster, academic-related time constraints were the primary barrier to booster completion. Among those who completed the booster, the booster lesson was perceived as worthwhile, satisfaction was high, and the length was perceived as appropriate. Future research should examine if flexible delivery of booster lessons in terms of timelines and therapist support would increase booster uptake. Key learning aims: As a result of reading this paper, readers should: (1) Understand the uptake of a self-guided booster lesson in internet-delivered cognitive behaviour therapy (ICBT) among post-secondary students. (2) Understand students' preferences for the content, timing, and therapist support for booster lessons. (3) Understand the need for alternative delivery methods of booster lessons to reach students who might benefit the most from a booster. [ABSTRACT FROM AUTHOR]

Specific phobia of vomiting (SPOV) can be a severe and debilitating anxiety disorder and affects women in the childbearing years. The perinatal period and early parenthood is a time of increased risk for the onset or exacerbation of anxiety problems, which can have an impact on both the woman and the developing child. There are particular issues pertinent to the physical experience of pregnancy and tasks of early caregiving that women with SPOV may find difficult or distressing to confront, but these are not well documented. Cognitive behavioural therapy (CBT) focused on exposure to vomit cues and processing distressing early memories of vomiting is an effective treatment for SPOV. This paper describes the successful CBT treatment of two young mothers with SPOV, outlining the challenges faced by parents at this time and the need to take this into account in treatment, using illustrative case material. Key learning aims: (1) To understand how specific phobia of vomiting (SPOV) affects women in early parenthood. (2) To know how to target and update traumatic early memories of vomiting with imagery rescripting. (3) To know how to design and carry out effective behavioural experiments for perinatal SPOV. (4) To understand how to take mother, baby, and the mother–infant relationship into account in SPOV treatment. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioural therapy (CBT) is in high demand due to its strong evidence base and cost effectiveness. To ensure CBT is delivered as intended in research, training and practice, fidelity assessment is needed. Fidelity is commonly measured by assessors rating treatment sessions, using CBT competence scales (CCSs). Aims: The current review assessed the quality of the literature examining the measurement properties of CCSs and makes recommendations for future research, training and practice. Method: Medline, PsychINFO, Scopus and Web of Science databases were systematically searched to identify relevant peer-reviewed, English language studies from 1980 onwards. Relevant studies were those that were primarily examining the measurement properties of CCSs used to assess adult 1:1 CBT treatment sessions. The quality of studies was assessed using a novel tool created for this study, following which a narrative synthesis is presented. Results: Ten studies met inclusion criteria, most of which were assessed as being 'fair' methodological quality, primarily due to small sample sizes. Construct validity and responsiveness definitions were applied inconsistently in the studies, leading to confusion over what was being measured. Conclusions: Although CCSs are widely used, we need to pay careful attention to the quality of research exploring their measurement properties. Consistent definitions of measurement properties, consensus about adequate sample sizes and improved reporting of individual properties are required to ensure the quality of future research. [ABSTRACT FROM AUTHOR]

Background: Addison's disease (AD) is a rare chronic illness caused by adrenocortical insufficiency. Due to the pivotal role of the regulating hormone cortisol in AD, there is a common symptom overlap between the presentation of anxiety and adrenal crisis. Previous literature has identified the prevalence of anxiety in endocrinological disorders, however there is a paucity of research examining the complex interplay between AD and anxiety. Aims: This paper describes a single case study of a patient with severe health anxiety and co-morbid AD. The aims of the study were to establish if standard cognitive behavioural therapy for health anxiety in AD can lead to a reduction in psychological distress, and whether this approach is an effective intervention for the reduction of Emergency Department admissions. Method: A single case design was used, with pre- and post-measures of health anxiety, general anxiety and depression. Data on Emergency Department admissions prior to and following treatment were used to assess change in this domain. Results: Reliable and clinically significant reductions were seen across all measures, from severe to sub-clinical levels. There was a complete amelioration of Emergency Department admissions in the 12 months following completion of treatment. Conclusions: This preliminary study provides a sound rationale for further research into AD complicated by anxiety. Findings support the clinical utility of the cognitive behavioural therapy model for complex presentations of AD, offering a potential treatment option where anxiety is elevated and interfering with self-management and leading to high levels of health service use. [ABSTRACT FROM AUTHOR]

Background: Approximately one in three children and young people with chronic fatigue syndrome (CFS/ME) also have probable depression. Cognitive behaviour therapy (CBT) has a growing evidence base as an effective treatment approach for CFS/ME and for depression in this population. Aims: Given the high degree of co-morbidity, this discussion paper aims to compare and contrast CBT for CFS/ME and CBT for depression in children and young people. Method: The existing literature on CBT for depression and CBT for CFS/ME, in relation to children and young people was reviewed. Results: Whilst there are commonalities to both treatments, the cognitive behavioural model of CFS/ME maintenance includes different factors and has a different emphasis to the cognitive behavioural model of depression, resulting in different intervention targets and strategies in a different sequence. Conclusions: A collaborative, formulation-driven approach to intervention should inform the intervention targets and treatment strategies. [ABSTRACT FROM AUTHOR]

BackgroundJob loss, debt and financial difficulties are associated with increased risk of mental illness and suicide in the general population. Interventions targeting people in debt or unemployed might help reduce these effects.MethodWe searched MEDLINE, Embase, The Cochrane Library, Web of Science, and PsycINFO (January 2016) for randomized controlled trials (RCTs) of interventions to reduce the effects of unemployment and debt on mental health in general population samples. We assessed papers for inclusion, extracted data and assessed risk of bias.ResultsEleven RCTs (n = 5303 participants) met the inclusion criteria. All recruited participants were unemployed. Five RCTs assessed ‘job-club’ interventions, two cognitive behaviour therapy (CBT) and a single RCT assessed each of emotional competency training, expressive writing, guided imagery and debt advice. All studies were at high risk of bias. ‘Job club’ interventions led to improvements in levels of depression up to 2 years post-intervention; effects were strongest among those at increased risk of depression (improvements of up to 0.2–0.3 s.d. in depression scores). There was mixed evidence for effectiveness of group CBT on symptoms of depression. An RCT of debt advice found no effect but had poor uptake. Single trials of three other interventions showed no evidence of benefit.Conclusions‘Job-club’ interventions may be effective in reducing depressive symptoms in unemployed people, particularly those at high risk of depression. Evidence for CBT-type interventions is mixed; further trials are needed. However the studies are old and at high risk of bias. Future intervention studies should follow CONSORT guidelines and address issues of poor uptake. [ABSTRACT FROM PUBLISHER]