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Background Data on the long-term impact of SARS-CoV-2 infection in children and young people (CYP) is conflicting. We assessed evidence on long-term post-COVID symptoms in CYP examining prevalence, risk factors, type and duration. Methods: Systematic search of published and unpublished literature using 13 online databases between 01/12/2019 – 31/07/2021. Eligible studies reported CYP ≤19 years with confirmed or probable SARS-CoV-2 with any symptoms persisting beyond acute illness. Random effects meta-analyses examined pooled risk difference in symptom prevalence (controlled studies only) and pooled prevalence (uncontrolled studies also included). Meta-regression examined study characteristics hypothesised to be associated with symptom prevalence. Prospectively registered: CRD42021233153. Findings Twenty two of 3357 unique studies were eligible, including 23,141 CYP. Median duration of follow-up was 125 days (IQR 99-231). Pooled risk difference in post-COVID cases compared to controls (5 studies) were significantly higher for cognitive difficulties (3% (95% CI 1, 4)), headache (5% (1, 8)), loss of smell (8%, (2, 15)), sore throat (2% (1, 2)) and sore eyes (2% (1, 3)) but not abdominal pain, cough, fatigue, myalgia, insomnia, diarrhoea, fever, dizziness or dyspnoea. Pooled prevalence of symptoms in post-COVID participants in 17 studies ranged from 15% (diarrhoea) to 47% (fatigue). Age was associated with higher prevalence of all symptoms except cough. Higher study quality was associated with lower prevalence of all symptoms, except loss of smell and cognitive symptoms. Interpretation The frequency of the majority of reported persistent symptoms was similar in SARS-CoV-2 positive cases and controls. This systematic review and meta-analysis highlights the critical importance of a control group in studi7777es on CYP post SARS-CoV-2 infection.

Background There is little understanding of the mental health impact for young people with long-term physical health conditions and mental health professionals’ experiences of supporting them during COVID-19. This service evaluation aimed to conduct a survey of the psychological services provided by mental health professionals in a paediatric hospital in relation to COVID-19. Method Clinical psychologists and assistant psychologists ( n = 76) across the hospital were asked to complete a survey, asking about their perceptions of COVID-19’s impact on patients and families and experiences of providing support during COVID-19. Open-ended survey questions were analysed qualitatively using framework analysis. Results Respondents described perceived impacts on patients and families around social isolation, school closure, family relationships, physical health, mental health, treatments and social support. Respondents’ experiences of providing mental health support during COVID-19 highlighted themes around providing remote/virtual support, workload and facilitators and barriers to their work. Conclusions Mental health professionals surveyed reported a complex mental health landscape in young people with long-term physical health conditions and their families during COVID-19. Service-wide involvement is needed to facilitate changes to support vital adaptations to remote/virtual working. Research on the mental health of young people with long-term physical health conditions and staff experiences of providing support is warranted.

Introduction: Chronic loneliness has been linked to many adverse outcomes, including mental health problems. Psychological treatment of loneliness can be effective, but the evidence base is limited. Objective: To investigate the efficacy of 2 internet-based interventions based on cognitive behavioral therapy (ICBT) and interpersonal psychotherapy (IIPT) relative to a wait-list control group and each other. Methods: A total of 170 participants were recruited and randomized to either 9 weeks of ICBT (n = 68), IIPT (n = 68), or a wait-list condition (n = 34). The primary outcome was loneliness, measured using the UCLA Loneliness Scale before, during, and after treatment. Secondary measures of psychiatric disorders and quality of life were administered before and after treatment. Follow-up was conducted 4 months after the treatment had ended. Primary outcome data were analyzed using growth curve modeling. Secondary outcomes were analyzed using robust regression models. The trial was preregistered (ClinicalTrials.gov ID: NCT03807154). Results: The ICBT condition had a significantly greater impact on loneliness compared to the wait-list and IIPT conditions. Effect sizes were moderate to large (Cohen d = 0.71) compared to the wait-list and moderate (d = 0.53) compared to IIPT. The IIPT condition did not differ significantly from the wait-list. Both active treatments led to significant increases in quality of life. Only the ICBT group had significantly lower symptoms of depression and generalized anxiety compared to the wait-list group. Treatment gains were maintained but not improved at follow-up. Conclusions: ICBT can be an efficacious option for alleviating loneliness. The IIPT intervention was not as effective.

BackgroundChildren and young people with long-term physical conditions have significantly elevated mental health needs. Transdiagnostic, brief psychological interventions have the potential to increase access to evidence-based psychological treatments for patients who attend health services primarily for physical health needs.ObjectiveA non-randomised study was conducted to assess the impact of brief, transdiagnostic psychological interventions in children and young people presenting at a drop-in mental health centre in the reception area of a paediatric hospital.Methods186 participants attending a transdiagnostic mental health drop-in centre were allocated to assessment and psychological intervention based on a clinical decision-making algorithm. Interventions included signposting, guided self-help based on a modular psychological treatment and referral to the hospital’s paediatric psychology service. The primary transdiagnostic mental health outcome measure was the parent-reported Strengths and Difficulties Questionnaire (SDQ), which was given at baseline and 6 months post-baseline.FindingsThere was a significant positive impact of attending the drop-in mental health centre on the SDQ (Cohen’s d=0.22) and on the secondary outcome measure of Paediatric Quality of life (Cohen’s d=0.55).ConclusionsA mental health drop-in centre offering brief, transdiagnostic assessment and treatment may reduce emotional and behavioural symptoms and improve quality of life in children and young people with mental health needs in the context of long-term physical conditions. A randomised controlled trial to investigate the specificity of any effects is warranted.Clinical implicationsDrop-in centres for mental health needs may increase access and have beneficial effects for children and young people with physical conditions.

There are potent evidence-based psychological treatments for youth with mental health needs, yet they are rarely implemented in clinical practice, especially for youth with mental health disorders in the context of chronic physical illness such as epilepsy. Implementation science, the study of the translation of research into practice, can promote the uptake of existing effective interventions in routine clinical practice and aid the sustainable integration of psychological treatments with routine health care. The aim of this report was to use four implementation science methods to develop a version of an existing effective psychological treatment for mental health disorders [the Modular Approach to Treatment of Children with Anxiety, Depression or Conduct Problems (MATCH-ADTC)] for use within paediatric epilepsy services: (a) literature search; (b) iterative focus groups underpinned by normalisation process theory; (c) Plan–Do–Study–Act methods; and (d) qualitative patient interviews. Findings: Three modifications were deemed necessary to facilitate implementation in children with both mental health disorders and epilepsy. These were (a) a universal brief psychoeducational component addressing the relationship between epilepsy and mental health; (b) supplementary, conditionally activated interventions addressing stigma, parental mental health and the transition to adulthood; and (c) additional training and supervision. The intervention needed relatively little alteration for implementation in paediatric epilepsy services. The modified treatment reflected the scientific literature and the views of clinicians and service users. The multi-method approach used in this report can serve as a model for implementation of evidence-based psychological treatments for children with mental health needs in the context of other chronic illnesses.

Background Children with chronic health conditions and their parents are at greater risk of developing emotional and behavioural problems compared to their physically healthy peers. The psychological impact on parents is crucial to understand given the relationship between parental mental health and child emotional and behavioural difficulties. This study was part of a broader research project examining the acceptability, feasibility and impact of a ‘Mental Health and Psychological Wellbeing Drop‐in Centre’ in a paediatric hospital providing access to support and intervention for children and their families. This paper aimed to investigate the impact of the centre on parents (n = 148). Methods Parental anxiety and depression were assessed using the GAD‐7 and PHQ‐9 at baseline and 6‐month post‐baseline. Child mental health was assessed using the parent‐report Strengths and Difficulties Questionnaire (SDQ). If parents had significant mental health needs, a brief intervention/signposting to relevant services was provided. Results At baseline, 48% of parents scored above clinical threshold for anxiety and 41% for depression, and parent reported child SDQ scores were correlated with parental anxiety and parental low mood. Self‐reported parental anxiety and low mood decreased at 6‐months post‐baseline (parental anxiety: mean decrease = 2.29 [1.22–3.36], d = 0.38; parental low mood: mean decrease = 1.81 [0.64–3.00], d = 0.28). There were no significant correlations between change in parent reported child wellbeing and changes in parental low mood and anxiety between baseline and 6‐month post‐baseline. Conclusions Assessing and providing a brief treatment to address the mental health needs of parents of children with comorbidity may bring important benefits. It is recommended that children's mental health services consider assessment of parental mental health as part of routine care.

Introduction: We describe post-COVID symptomatology in a national sample of 11-17-year-old children and young people (CYP) with PCR-confirmed SARS-CoV-2 infection compared to test-negative controls.Methods and analysis: A cohort study of test-positive (n=3,065) and age-, sex- and geographically-matched test-negative CYP (n=3,739) completed detailed questionnaires 3 months post-test.Results: At PCR-testing, 35.4% of test-positives and 8.3% of test-negatives had any symptoms whilst 30.6% and 6.2%, respectively, had 3+ symptoms. At 3 months post-testing, 66.5% of test-positives and 53.3% of test-negatives had any symptoms, whilst 30.3% and 16.2%, respectively, had 3+ symptoms. Latent class analysis identified two classes, characterised by “few” or “multiple” symptoms. This latter class was more frequent among test-positives, females, older CYP and those with worse pre-test physical and mental health.Discussion: Test-positive CYP had a similar symptom profile to test-negative CYP but with higher prevalence of single and, particularly, multiple symptoms at PCR-testing and 3 months later.

Objectives: This study aimed to investigate factors influencing referral of children with physical illness to paediatric psychology. Due to high rates of mental health problems within this population, studies have shown that referral to paediatric psychology should be increased. However, few studies have examined factors shaping healthcare professionals’ referral behaviour. Methods: This study used the theory of planned behaviour to develop a questionnaire which explores factors influencing the referral of children and families to paediatric psychology. Psychometric properties of the questionnaire were examined. Results: The questionnaire was found to have good reliability and validity. The main constructs of the theory of planned behaviour were useful in predicting intention to refer to paediatric psychology. Specific beliefs about referral were shown to influence intention to refer. Conclusion: Findings suggest that individual attitudes and beliefs can impact healthcare professionals’ referral behaviour, indicating that multidisciplinary interventions and inter-professional education relating to the psychological aspects of illness are required.

Young people with cancer are at increased risk of depression, yet evidence-based psychological interventions that are tailored to the specific needs of young people with cancer are scarce, and depression in this group may be particularly challenging to recognize and treat. The aims of this study were to (1) explore the views of health professionals in recognizing and treating low mood in young people with cancer and (2) identify the key components of an effective online treatment package for depression in this population.Eighteen NHS health professionals with a range of professional backgrounds working directly with young people with cancer were interviewed using a semi-structured interview schedule. Responses were analyzed using thematic analysis.Five themes emerged: (1) one size doesn't fit all-the nature of depression is complex and varied, and symptoms fluctuate greatly in relation to physical health; (2) distress is completely understandable-it is important not to pathologize a normal reaction; (3) a stepping stone intervention-online interventions may promote engagement with face-to-face therapy; (4) connecting with others-the intervention should promote sharing experiences with others to reduce isolation; and (5) ownership and empowerment-lack of independence may be a cause of distress, and young people should have control of the intervention.The nature of depression in young people with cancer is complex and multifaceted. Online guided self-help may be useful when added as a component or first step of a treatment package including face-to-face talking therapies.

The general population has experienced a significant elevation in fear and anxiety during COVID-19 both as a direct result of the virus but also due to measures taken to prevent it spreading, such as the need to stay inside and increase hand-washing. Lockdown has been used in many/most countries to prevent widespread infection. The advice and imposed actions are necessary to prevent the virus from spreading, but they might exacerbate the problems experienced by people with a preexisting anxiety-related disorder. The treatment of anxiety-related disorders can be provided while in quarantine. Staying at home in self-isolation does not preclude obtaining psychological treatment for anxiety-related disorders. Dealing with cognitive biases, over-estimations of threat, intolerance of uncertainty, inflated responsibility and excessive safety behavior, are useful clinical directions.

Background Mental health disorders in the context of long-term conditions in children and young people are currently overlooked and undertreated. Evidence-based psychological treatments for common childhood mental health disorders (anxiety, depression and disruptive behaviour disorders) have not been systematically evaluated in young people with epilepsy despite their high prevalence in this population. The aim of this multi-site randomised controlled trial is to determine the clinical and cost-effectiveness of adding a modular psychological intervention to usual care for the mental health disorders in comparison to assessment-enhanced usual care alone. Methods In total, 334 participants aged 3–18 years attending epilepsy services will be screened for mental health disorders with the Strengths and Difficulties Questionnaire (SDQ) and the diagnostic Development and Wellbeing Assessment (DAWBA). Those identified as having a mental health disorder and consenting to the trial will be randomised to either receive up to 22 sessions of the modular psychological intervention (MATCH-ADTC) delivered over the telephone over 6 months by non-mental health professionals in addition to usual care or to assessment-enhanced usual care alone. Outcomes will be measured at baseline, 6 months and 12 months post-randomisation. It is hypothesised that MATCH-ADTC plus usual care will be superior to assessment-enhanced usual care in improving emotional and behavioural symptoms. The primary outcome is the SDQ reported by parents at 6 months. Secondary outcomes include parent-reported mental health measures such as the Revised Children’s Anxiety and Depression Scale, quality of life measures such as the Paediatric Quality of Life Inventory and physical health measures such as the Hague Seizure Severity Scale. Outcome assessors will be blinded to group assignment. Qualitative process evaluations and a health economic evaluation will also be completed. Discussion This trial aims to determine whether a systematic and integrated approach to the identification and treatment of mental health disorders in children and young people with epilepsy is clinically and cost-effective. The findings will contribute to policies and practice with regard to addressing mental health needs in children and young people with other long-term conditions. Trial registration ISRCTN ISRCTN57823197. Registered on 25 February 2019.

Background: Data on the long-term impact of SARS-CoV-2 infection in children and young people (CYP) is conflicting. We assessed evidence on long-term post-COVID symptoms in CYP examining prevalence, risk factors, type and duration. Methods: Systematic search of published and unpublished literature using 13 online databases between 01/12/2019 – 31/07/2021. Eligible studies reported CYP ≤19 years with confirmed or probable SARS-CoV-2 with any symptoms persisting beyond acute illness. Random effects meta-analyses examined pooled risk difference in symptom prevalence (controlled studies only) and pooled prevalence (uncontrolled studies also included). Meta-regression examined study characteristics hypothesised to be associated with symptom prevalence. Prospectively registered: CRD42021233153. Findings: Twenty two of 3357 unique studies were eligible, including 23,141 CYP. Median duration of follow-up was 125 days (IQR 99-231).Pooled risk difference in post-COVID cases compared to controls (5 studies) were significantly higher for cognitive difficulties (3% (95% CI 1, 4)), headache (5% (1, 8)), loss of smell (8%, (2, 15)), sore throat (2% (1, 2)) and sore eyes (2% (1, 3)) but not abdominal pain, cough, fatigue, myalgia, insomnia, diarrhoea, fever, dizziness or dyspnoea.Pooled prevalence of symptoms in post-COVID participants in 17 studies ranged from 15% (diarrhoea) to 47% (fatigue). Age was associated with higher prevalence of all symptoms except cough. Higher study quality was associated with lower prevalence of all symptoms, except loss of smell and cognitive symptoms. Interpretation: The frequency of the majority of reported persistent symptoms was similar in SARS-CoV-2 positive cases and controls. This systematic review and meta-analysis highlights the critical importance of a control group in studies on CYP post SARS-CoV-2 infection. Funding: None to declare. Declaration of Interest: SAB, RS, SDB, AXDZ, LLO, SNL, BLDS, RMV and OVS have no conflicts of interest. TJS is the Chair of the Health Research Authority for England who reimburse his university for his time. He is not paid personally. He has recused himself from research studies in which he is personally involved and which require ethical approval from the HRA.

Background: Perfectionism in adolescence has received increased attention, but few studies have examined this in non-clinical samples. This study investigated perfectionism among adolescents from the general population in relation to demographic factors.Methods: The present study is cross-sectional and draws on the epidemiological youth@hordaland study. The sample consisted of 10.217 adolescents aged 16–19 years (52.9% girls). Self-reported perfectionism was assessed by the EDI-P scale from the Eating Disorder Inventory with two dimensions of perfectionism, namely self-oriented (SOP) and socially prescribed (SPP) perfectionism, and a total score. Perfectionism was analyzed in relation to age, gender, and socioeconomic status (SES) by perceived economic well-being and parental education level. Chi-squared tests, t-tests, and regression analyses were performed.Results: There were few gender differences on the mean scores on perfectionism, with similar levels on the total score of EDI-P and SOP, while girls scored slightly higher on SPP (p < 0.001). The latter gender difference represented a small effect size (Cohen's d = 0.053). Chi-square analyses with perfectionism split at the 90th percentile across gender showed that there were significantly more girls than boys among the high scorers both for EDI-P, EDI-SOP, and EDI-SPP. There were no significant differences between levels of perfectionism between the three age groups. The logistic regression analyses adjusted by age and gender showed that adolescents with a better perceived economic well-being had increased odds of high perfectionism. This was evident for overall EDI-P (OR = 1.760, 95% CI = 1.493–2.076), SOP (OR = 1.543, 95% CI = 1.292–1.843), and SPP (OR = 1.836, 95% CI = 1.559–2.163). Parental education was not significantly associated with perfectionism scores among the adolescents.Conclusions: The levels of perfectionism were relatively similar between the genders in the present study, besides slightly higher SPP among girls than boys. There were also significantly more girls than boys among the high scorers on overall perfectionism, SOP, and SPP, respectively. High perfectionism was related to SES for perceived economic well-being, but not for parental education level. Implications for further research and clinical interventions were suggested.

Background Children and young people with long term physical health conditions (LTC) are known to have higher levels of co-morbid mental health problems than medically healthy children. Evidence-based treatments for mental health problems are effective in children who also have an LTC. A drop-in centre in a paediatric hospital, delivering a range of interventions including onward referral, signposting and guided self-help, may be one way to complement existing mental health services as part of a stepped-care approach. The aim of this study was to understand patients’ perspectives of the centre. Methods 128 patients attending a drop-in centre at Great Ormond Street Hospital were invited to participate. Overall, 35 participated in semi-structured interviews (either in person or by phone) exploring their experience of the drop-in centre. Interviews were audio-recorded, transcribed, and analysed using Framework analysis. Results Overall, participants found the drop-in centre highly acceptable and reported a positive experience. Reasons for this varied, but broadly focused around four areas:(1) Choice in how to access the intervention and feeling empowered afterwards; (2) Having someone to talk to who could provide them with practical support; (3) Integration and parity of physical and mental health care; (4) The intervention being sufficient to meet their needs and quick to access. Discussion Participants found the intervention feasible and acceptable. A drop-in centre in a paediatric hospital appears to be a positive and valued adjunct to supplement existing mental health services at GOSH.

The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.

Background: Epilepsy is one of the most common chronic paediatric conditions. Children and young people with epilepsy are at a significantly higher risk of developing mental health problems relative to the general population, yet the majority of these problems are unrecognised and under-treated in clinical practice. Although there is little epilepsy-specific guidance as to what interventions to use, researchers suggest there is no reason why clinicians should not be using the evidence base. Given the poor prognosis of untreated mental health difficulties, this cohort study sought to identify what psychological treatment young people with epilepsy with mental health needs receive in routine practice. Methods: Participants were children and young people aged 3 to 18 attending paediatric neurology clinics. The parents of those children who met threshold for impairing symptoms on the Strengths and Difficulties questionnaire were asked to complete the Development and Well-being Assessment (DAWBA), an online clinical assessment designed to generate psychiatric diagnoses. Participants who met clinical threshold for a disorder according to the DAWBA were provided with a bespoke measure asking questions regarding their experience with treatment for mental health support. Results: 16 of the 46 parents who completed the DAWBA reported that they had experienced previous or current support for their child’s mental health difficulties. The mental health support offered to families was highly variable, inadequate and often not clearly compliant with existing UK National Institute for Health and Clinical Excellence (NICE) guidelines for mental health treatment in children and young people. Conclusions: The present study demonstrates the inconsistency and inadequacy of mental health provision for children and young people with epilepsy. Future work should explore reasons for the treatments offered failing to adhere to existing guidance for mental health difficulties in children, as well as possible solutions to this.

Background: This study evaluated whether clinical and economic outcomes from CBT for child anxiety disorders in the context of maternal anxiety disorders are improved by adding treatment focused on (i) maternal anxiety disorders, or (ii) mother-child interactions. Methods: 211 children (7 – 12 years, 85% White British, 52% female) with a primary anxiety disorder, whose mothers also had a current anxiety disorder, were randomised to receive (i) child-focused CBT with non-specific control interventions (CCBT+Con), (ii) CCBT with CBT for the maternal anxiety disorder (CCBT+MCBT), or (iii) CCBT with an intervention targeting the mother-child interaction (CCBT+MCI). A cost-utility analysis from a societal perspective was conducted using mother/child combined Quality Adjusted Life Years (QALYs). [Trial registration: https://doi.org/10.1186/ISRCTN19762288]. Results: MCBT was associated with immediate reductions in maternal anxiety compared to the non-specific control; however, after children had also received CCBT, maternal outcomes in the CCBT+MCI and CCBT+Con arms improved and CCBT+MCBT was no longer superior. Neither CCBT+MCBT nor CCBT+MCI conferred a benefit over CCBT+Con in terms of child anxiety disorder diagnoses post-treatment [primary outcome] (adj RR: 1.22 (95% CI 0.88, 1.67), p = .23; adj RR: 1.21 (95% CI 0.88, 1.65), p = .24 respectively) or global improvement ratings (adj RR 1.25 (95% CI 0.99, 1.57), p = .06; adj RR 1.18 (95% CI 0.93, 1.50), p = .17) or six and 12 months later. No significant differences between the groups were found on the main economic outcome measures (child/mother combined QALY mean difference: CCBT+MCBT vs CCBT+Con: -0.04 (95% CI -0.12, 0.04), p = 0.29; CCBT+MCI vs CCBT+Con: 0.02 (95% CI -0.05, -0.09), p = 0.54). CCBT+MCI was associated with non-significantly higher costs than CCBT (mean difference: £154 (95% CI -£1239, £1547), p = 0.83) but, when taking into account sampling uncertainty, it may be cost-effective compared with CCBT alone. Conclusions: Good outcomes were achieved for children and their mothers across treatment arms. There was no evidence of significant clinical benefit from supplementing CCBT with either CBT for the maternal anxiety disorder or treatment focussed on mother-child interactions, but the addition of MCI (and not MCBT) may be cost-effective. Keywords: Child; anxiety; mother; parent-child interaction; CBT.

ObjectiveWe aimed to test the feasibility of using an online parent-completed diagnostic assessment for detecting common mental health disorders in children attending neurology clinics. The assessment does not require intervention by a mental health professional or additional time in the clinic appointment.SettingTwo parallel and related screening studies were undertaken: Study 1: Tertiary paediatric neurology clinics. Study 2: Secondary and tertiary paediatric neurology clinics.PatientsStudy 1: 406 Young people aged 7–18 attending paediatric neurology clinics. Study 2: 225 Young people aged 3–18 attending paediatric epilepsy clinics.InterventionsParents completed online versions of the Strengths and Difficulties Questionnaire (SDQ) and Development and Well-being Assessment (DAWBA).Main outcome measuresWe investigated: the willingness of families to complete the measures, proportion identified as having mental health disorders, time taken to complete the measures and acceptability to families and clinicians.ResultsThe mean total difficulties score of those that had completed the SDQ fell in the ‘high’ and ‘very high’ ranges. 60% and 70% of the DAWBAS completed met criteria for at least one DSM-IV disorder in study 1 and 2 respectively. 98% of the parents reported that the screening methods used were acceptable.

Background: Most people with common mental health problems do not seek evidence-based psychological interventions. Aims: The aim of this study was to investigate whether monitoring symptoms of depression and anxiety using an app increased treatment-seeking. Method: Three hundred and six people with significant levels of anxiety and depression, none of whom were currently receiving treatment, were randomly allocated to receive either (a) information about local psychological services only, (b) information plus regular symptom monitoring (every 6 days), or (c) information plus open symptom monitoring (monitoring when they felt like it). An app was used to provide information and monitor mood. Results: The proportion of participants who reported receiving treatment after starting the study was 7.2% (10/138) in the information only group, 8.1% (9/111) in the information plus regular monitoring group and 15.8% (9/57) in the information plus open monitoring group. There was a trend for participants who were able to monitor whenever they wished to be more likely to report receiving treatment than people who were only given information about their local treatment services. The impact of the intervention was greatest among participants who intended to seek treatment before taking part. Limitations were that only a small minority of those who downloaded the app completed the study and that the study relied on self-reported measures of treatment-seeking. Conclusions: Symptom monitoring can increase actual treatment-seeking in those with an intention to seek treatment.

ObjectiveThis study aimed to conduct a randomised pilot trial to assess the feasibility of a randomised controlled trial (RCT) to investigate the effect of telephone-guided self-help for the treatment of mental health difficulties in children with neurological conditions.DesignPreliminary RCT. The primary outcome measure was the Strengths and Difficulties Questionnaire.SettingNeurology clinics in a national tertiary paediatric hospital.PatientsYoung people attending neurology clinics who met criteria for mental health difficulties according to the Development and Wellbeing Assessment.Interventions12 weeks of telephone-guided self-help based on a modular approach to psychological therapy for children delivered to children and/or their parents (n=17; eight males; mean age 12.04 years, SD=3.34) or a waiting list for telephone-guided self-help with no additional intervention over 12 weeks (n=17; nine males; mean age 10.53 years, SD=3.14).Results124 participants completed the DAWBA, and 34 children and young people were entered into the trial. 65% of those randomised to the intervention arm completed the full intervention, and the intervention was acceptable to those completing it. However, there were significant problems related to lack of data completion (38% data loss for primary outcome measure), choice of control comparator and outcome measures. Due to significant loss of data at follow-up, the effect size findings are considered unreliable.ConclusionsFurther feasibility work should be conducted to improve data completeness before progression to a definitive trial of guided self-help for mental health problems in children with neurological conditions can be recommended.Trial registration numberISRCTN21184717.

Objective Children with neurological conditions such as epilepsy are at high risk of developing mental health disorders. Guided self-help can be used to increase access to psychological therapies. When developing and evaluating interventions, it is important to obtain the views of service-users about their acceptability. A telephone-guided self-help intervention was used to treat common mental health difficulties in children and young people with neurological conditions. The intervention was not adapted in content to account for chronic illness. This study therefore reports on qualitative interviews with participants to determine the acceptability of the intervention. Methods Semi-structured interviews were conducted with 27 participants (25 parents and 2 young people) who had undertaken a telephone-delivered guided self-help intervention for common mental health difficulties in the context of a paediatric neurological condition. Transcripts were analysed thematically using the framework approach. Results Thirteen themes were extracted, organised into three main domains, which covered: the practicalities of telephone guided self-help treatment; the outcomes of the intervention; and the extent to which adaptation was needed for chronic illness. Most families found the intervention helpful in working towards their specific goals and noticed changes for the child and/or parents and family. Conclusions Participants had a positive experience of the intervention and the majority of parents found the standard intervention with individualised goals sufficient to meet the young person's mental health needs.

Background Mental contamination, the experience of feeling dirty in the absence of physical uncleanliness, is closely associated with obsessive compulsive disorder (OCD). Given that many features of OCD are found in other diagnoses, the primary aim of this study was to determine whether mental contamination is specific to OCD or whether it is also associated with psychopathology found in other disorders. We hypothesised that, in addition to OCD symptoms, mental contamination would be associated with other psychopathology, in particular symptoms of depression, anxiety and eating disorders, and with transdiagnostic processes such as perfectionism. Methods 120 participants (82%) completed measures of psychological disorders and transdiagnostic processes. Results were analysed using Pearson's r correlations and a multiple regression analysis. Results Mental contamination was most strongly associated with symptoms of OCD but was also associated with eating disorder symptoms, depression and anxiety. It was also correlated with perfectionism, intolerance of uncertainty and fear of compassion. OCD, eating disorder symptoms, fear of compassion and low self-esteem were significant independent predictors of mental contamination. Conclusions Mental contamination is associated with a range of psychopathology but is most strongly associated with symptoms of OCD. Further research is warranted to advance treatment for mental contamination.

Mental contamination is defined and the main features of the phenomenon are set out. In addition to the familiar form of abnormal mental contamination, as evident in psychological disorders, notably Obsessive-compulsive Disorder, the phenomenon of non-clinical mental contamination is common. The clinical form is distressing, uncontrollable, constant and dysfunctional. The normal phenomenon can be disturbing but it is usually dormant, evoked intermittently, transient, tolerable, manageable, not dysfunctional and psychologically fascinating. The cognitive theory of mental contamination encompasses the causes of mental contamination, its persistence, and individual vulnerability. The field would benefit greatly from additional work, such as that reported elsewhere in this Special Issue, to incorporate the unusual manifestations of visual contamination, morphing and self-contamination, and to account for the experience of mental contamination in nonclinical and other clinical manifestations.

Context This review summarizes the current randomized controlled trials literature on psychological and physical outcomes of psychosocial interventions in pediatric oncology. Objectives The objective of this study was to evaluate the effectiveness and impact of psychosocial interventions in children with cancer. Methods A search of the literature resulted in a total of 12 randomized clinical trials and these have evaluated psychosocial interventions in children younger than 18 years with current and previous diagnoses of cancer. Outcome measures were both psychological (e.g., symptoms of anxiety, depression, quality of life, and self-esteem) and physical (e.g., cancer symptoms, treatment adherence, and pain). Interventions identified included cognitive behavioral therapy (CBT; n = 4), joint CBT and physical exercise therapy ( n = 1), family therapy ( n = 2), therapeutic music video ( n = 2), self-coping strategies ( n = 1), a wish fulfillment intervention ( n = 1), and joint family therapy and CBT ( n = 1). Results Nine studies reported statistically significant improvements on psychological outcomes. These findings suggest that psychosocial interventions are effective at reducing anxiety and depressive symptoms as well as improving quality of life. Additionally, six studies found psychosocial interventions to have a positive impact on physical symptoms and well-being, including a reduction in procedural pain and symptom distress. Conclusion These findings suggest that mental health needs in pediatric oncology patients can and should be addressed, potentially which will lead to better mental and physical health outcomes.

Background: Psychological treatments occupy an important place in evidence-based mental health treatments. Now is an exciting time to fuel treatment research: a pressing demand for improvements is poised alongside new opportunities from closer links with sister scientific and clinical disciplines. The need to improve mental health treatment is great; even the best treatments do not work for everyone, treatments have not been developed for many mental disorders, and the implementation of treatments needs to address worldwide scalability. Psychological treatments have yet to benefit from numerous innovations that have occurred in science, particularly those that have emerged in the past 20 years, and arguably vice versa. This Commission comprises ten parts that each outline an area in which we see substantial opportunity and scope for advancements that will move psychological treatments research forward. / Part 1: How do existing treatments work? Making the case for the mechanisms of psychological treatments Beyond knowing that an intervention is efficacious, research initiatives are needed that clarify the key mechanisms through which interventions work. An experimental psychopathological approach enables the identification of mechanisms. Research on these mechanisms has considerable scope to facilitate treatment innovation. / Part 2: Where can psychological treatments be deployed? Research to improve mental health worldwide We outline a number of factors to facilitate worldwide access to psychological treatments. Future research initiatives need to continue to develop and assess the efficacy of brief and flexible interventions that can be adapted to meet the needs of individuals across cultural contexts, and delivered and disseminated in a sustainable way. / Part 3: With what? The potential for synergistic treatment effects—using and developing cross-modal treatment approaches The combination of psychological and pharmacological treatments needs to be better understood, both in terms of the clinical effect and the underlying shared and different mechanisms. Efforts to develop and investigate the efficacy of novel cross-modal treatments could contribute to treatment innovation. / Part 4: When in life? Psychological science, prevention, and early intervention—getting the approach right from the start The social and economic tolls of mental health problems early in life make the development of effective prevention and early intervention approaches a priority. A preventive focus and a developmental approach are needed to identify risk factors for psychopathology, and identification of the optimal time at which to offer prevention approaches is needed to increase the likelihood of vulnerable young people growing up with positive mental health. / Part 5: Technology—can we transform the availability and efficacy of psychological treatment through new technologies? New technologies provide exciting and timely means by which to disseminate and extend the efficacy and global reach of evidence-based interventions. eHealth and mHealth approaches that use information technology (eg, the internet, virtual reality, serious gaming) and mobile and wireless applications (eg, text messaging, apps) are examples of how technology has been harnessed to innovate psychological treatments and their availability and evaluation. / Part 6: Trials to assess psychological treatments The findings of randomised controlled trials that assess psychological therapies inform policy and practice. Accordingly, the design and conduct of these trials warrants scrutiny and ongoing efforts for quality improvement (eg, reporting standards, specification of protocols, inclusion and exclusion criteria, choice of outcome measures, measurement of adverse effects, and prevention of bias in design and analysis). We outline several opportunities for further improvement that should enhance the credibility and quality of future trials. / Part 7: Training—can we cultivate a vision for interdisciplinary training across mental health sciences to improve psychological treatments? Early examples of collaboration between basic scientists and clinicians translated into historical steps in the innovation of psychological treatment. Such synergy has become less apparent in the past few years. The improvement in links between clinical psychology, psychiatry, and basic research has the potential to deliver more advances in psychological treatments. We propose opportunities to improve training in interdisciplinary mental health sciences. This training approach would be the first step toward forging links between scientists and clinicians in the next generation and bridging the gap between clinical practice and the basic research programmes that underpin psychological treatments. / Part 8: Whom should we treat, for what, and with what? Embracing the complexity of mental disorders from personalised models to universal approaches Mental disorders are inherently complex (eg, hetero-geneity in symptoms across disorders, high rates of comorbidity) and evidence-based treatments must address this complexity. Potential solutions include considering both highly individualised (ie, personalised) approaches and so-called universal or transdiagnostic approaches that target common mechanisms. A goal of future research will be to examine whether these approaches improve treatment effectiveness. / Part 9: Target: suicidal behaviour—protecting lives Suicidal behaviour is one of many areas in which advances are needed. Despite developments in the understanding of risk factors that predict the likelihood of suicide attempts, and the treatment and prevention of suicidal behaviour, many questions remain. We specify areas for future research—eg, use of new technologies, the role of culture, input from individuals with lived experience of suicidal behaviour, and using a team-based approach in the development, assessment, and dissem-ination of prevention efforts. / Part 10: Active innovation and scrutiny of future psychological treatments research The task of improving psychological treatments is an exciting prospect for scientists and clinicians with an interest in the so-called science of mental life. Clinicians, researchers, service users, carers, funders, commissioners, managers, policy planners, and change experts all have a part to play in improving psychological treatment. Some long-held ideas need examination, from the branding of psychological treatment types, to considering what people actually want treatment for. Scrutiny of new ideas should be rigorous and yet encourage innovation.

IntroductionThere is uncertainty surrounding the diagnosis, prevalence, phenotype, duration and treatment of Long COVID. This study aims to (A) describe the clinical phenotype of post-COVID symptomatology in children and young people (CYP) with laboratory-confirmed SARS-CoV-2 infection compared with test-negative controls, (B) produce an operational definition of Long COVID in CYP, and (C) establish its prevalence in CYP.Methods and analysisA cohort study of SARS-CoV-2-positive CYP aged 11–17 years compared with age, sex and geographically matched SARS-CoV-2 test-negative CYP. CYP aged 11–17 testing positive and negative for SARS-CoV-2 infection will be identified and contacted 3, 6, 12 and 24 months after the test date. Consenting CYP will complete an online questionnaire. We initially planned to recruit 3000 test positives and 3000 test negatives but have since extended our target. Data visualisation techniques will be used to examine trajectories over time for symptoms and variables measured repeatedly, separately by original test status. Summary measures of fatigue and mental health dimensions will be generated using dimension reduction methods such as latent variables/latent class/principal component analysis methods. Cross-tabulation of collected and derived variables against test status and discriminant analysis will help operationalise preliminary definitions of Long COVID.Ethics and disseminationResearch Ethics Committee approval granted. Data will be stored in secure Public Health England servers or University College London’s Data Safe Haven. Risks of harm will be minimised by providing information on where to seek support. Results will be published on a preprint server followed by journal publication, with reuse of articles under a CC BY licence. Data will be published with protection against identification when there are small frequencies involved.Trial registration numberISRCTN34804192; Pre-results.

The COVID-19 pandemic has had a severe impact on mental health worldwide, with increased rates of anxiety and depression widely documented. The aim of this study was to examine unguided low intensity cognitive behaviour therapy for anxiety and depression during the pandemic. A sample of 225 individuals in Australia and the United Kingdom (M age 37.79, SD = 14.02, range 18-80 years; 85% female) were randomised into intervention or waitlist control. The intervention group demonstrated significant decreases in anxiety (d = 0.36 [0.18, 0.54]) and depression (d = 0.28 [0.11, 0.45]) compared to controls. The majority of participants (96%) rated the intervention as useful, and most (83%) reported they spent 30 min or less reading the guide, with 83% agreeing the intervention was easy to read. The results indicate that low intensity cognitive behaviour therapy has efficacy in reducing anxiety and depression during the COVID-19 pandemic. There is an urgent need to disseminate low intensity psychological therapies to improve mental health in this challenging time.

Background If left untreated, obsessive compulsive disorder (OCD) can cause significant distress and impact on functioning throughout the lifespan. Despite the severity of the disorder, there is often a significant delay between the onset of symptoms and successful treatment. This is in part due to delays in recognising OCD symptoms in young people, particularly if the symptom forms are less common. Once OCD is accurately diagnosed, cognitive behavioural therapy (CBT) is known to be an efficacious treatment, sometimes in combination with medication, producing good long-term prognosis. It is therefore important to accurately detect OCD in children and young people so that they can be offered timely intervention. Use of the best tools in clinical and research settings improves detection and diagnosis, as well as enabling the tracking of progress through treatment. The aim of this current paper was to review measurement tools for OCD in young people with a focus on the practicalities of using tools in busy child mental health clinical settings. Method To discover what measurement tools are available for OCD in young people, we conducted a pragmatic literature of measurement tools for OCD in young people. We searched PsycINFO, Med-Line and the Cochrane databases for reports relating to the measurement of OCD. Additionally, we sought information from the National Institute for Health and Care Excellence (NICE) guidance, the Child Outcomes Research Consortium (CORC) website and the Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) Programme. We also reviewed large trials and meta-analyses of the treatment of OCD in young people and communicated with relevant researchers/clinicians. Results Seventeen questionnaire measurement tools, with variable psychometric properties, and four commonly used semistructured clinician administered interview measures were identified. Conclusions There are several measurement tools with good psychometric properties that are useful for initial screening/identification of OCD, as well as formal diagnosis, symptom tracking and treatment evaluation. With the availability of brief screens, as well as online diagnostic measures, such tools should not be a burden on clinical practice, but rather a helpful aid to support clinicians' assessment and treatment of OCD.

Treatment guidelines for eating disorders (ED) are unclear about the optimal length of psychological care. We aimed to investigate associations between treatment duration and changes in ED pathology. Data for 164 outpatients accessing psychological interventions for ED were analyzed using MANOVA. We tested associations between number of therapy sessions and pre-post treatment changes in clinical outcomes (EDE-Q global scores, binge eating, purging); adjusting for baseline measures, diagnoses, and treatment type. Secondary analyses included rapid response variables in the above outcomes by treatment session eight. Partial correlations between treatment duration and BMI changes (adjusting for intake BMI) were examined for anorexia nervosa cases. Treatment duration was not significantly associated with changes in ED outcomes after adjusting for rapid response. BMI change (weight regain) was not correlated with treatment duration in anorexia nervosa cases. Rapid response was associated with better EDE-Q outcomes, but not with changes in binge eating or purging behaviors. ED outcomes are unrelated to treatment duration; rapid response is a useful prognostic indicator for treatment planning.

Background: Medically unexplained symptoms affect between 4% and 20% of children and adolescents; 30–60% of these children also experience mental health difficulties. Trials and reviews have focussed on physical gains in this population, often overlooking mental health outcomes. Objectives: To use a systematic review methodology guided by the PRISMA checklist to (1) investigate the effectiveness of psychological interventions for mental health difficulties in children and adolescents with medically unexplained symptoms and (2) identify aspects of interventions associated with their success. Methods: Randomised controlled studies investigating the impact of psychological interventions on mental health in children and adolescents with medically unexplained symptoms were included. Systematic searches of PsycINFO, MEDLINE and CINAHL were undertaken from inception to January 2018. Studies were appraised using the quality appraisal checklist. A qualitative synthesis of studies was completed. Results: In all, 18 studies were identified. Interventions targeting parental responses to illness and family communication appeared to have the best outcomes. Conclusions: Psychological interventions may be effective in improving mental health outcomes within this population; however, evidence for the efficacy of these interventions is limited due to a high risk of bias within the majority of reviewed studies. Future research using rigorous methodology and non–cognitive behavioural therapy interventions is recommended.

Background Young people with a physical illness are at significantly greater risk of developing emotional and behavioural difficulties. Such problems may also have negative consequences on the management and course of the physical illness itself. This study was part of a broader project to examine the acceptability, feasibility and impact of a Mental Health and Psychological Wellbeing Drop-in Centre in a hospital setting. The aims of this particular pilot investigation were: (i) to establish whether there is a need for such a resource amongst the hospital’s patient population, (ii) to characterise the nature and severity of symptoms amongst patients presenting to the centre, and (iii) to establish the types of support that are requested and/or most needed. Methods A drop-in ‘booth’ located in the reception of Great Ormond Street Hospital (GOSH) was run by clinicians and researchers over the course of one week (Monday to Saturday), serving as a focus for recruitment and space for treatment, with a Clinical Psychologist or Psychiatrist on-call throughout. Basic demographic data were gathered and symptom severity measured using standardised emotional and behavioural difficulties questionnaires (SDQ, GAD-7 and PHQ-9). Results 31 participants were recruited from 28 families. The median age of young people presenting was 9 years (IQR: 6.5–11); 47% identified as White British and 55% were male. Primary problems identified included: anxiety (45%), challenging behaviour (31%) and low mood (21%). Whilst 75% of young people recruited were in the clinical range with respect to scores on the SDQ, 50% and 30% of parents scored in the clinical range for anxiety and depression, respectively. 32% of families reported never having received mental health input for their child. Conclusion A considerable proportion of patients and family members attending GOSH met the clinical threshold for common mental health problems, indicating a potential, as yet unmet, need.

Background Mental and physical health treatment should be delivered together for children and young people with epilepsy. Training healthcare professionals (HCPs) in epilepsy services to deliver mental health interventions is an important way to facilitate integrated care. Objective To determine the feasibility of remotely delivered assessment and psychological treatment for mental health difficulties delivered by HCPs in pediatric epilepsy clinics with limited formal training in psychological interventions. We hypothesized that it would be (i) feasible to train HCPs to deliver the psychological intervention and (ii) that participants receiving the psychological therapy would report reductions in symptoms of mental health difficulties including anxiety, depression, and behavior difficulties and improve quality of life. Methods Thirty-four children and young people with epilepsy who had impairing symptoms of a common mental health difficulty (anxiety, depression, disruptive behavior, and/or trauma) were allocated to receive 6 months of a modular cognitive behavioral intervention delivered by a HCP with limited formal psychological therapy experience. Thirteen HCPs were trained in delivery of the intervention. Healthcare professional competence was assessed in a two-stage process. Parent-reported measures of mental health symptoms and quality of life were completed at baseline and following the intervention. Paired t-tests were used to analyze changes in symptoms over time. Results All thirteen HCPs who participated in the training were considered competent in therapeutic delivery by the end of the training period. Twenty-three patients completed pre- and post-intervention measures and were included in the analysis. There were statistically significant improvements in: symptoms of mental health problems (p = 0.01; Cohen’s d = 0.62), total impact of mental health problems (p = 0.03; Cohen’s d = 0.52), anxiety and depression symptoms (p = 0.02; Cohen’s d = 0.57) and quality of life (p = 0.01; Cohen’s d = 0.57). Conclusion A modular cognitive behavioral treatment delivered over the telephone by HCPs with limited experience of psychological therapy was feasible and effective in treating mental health problems in children and young people with epilepsy. Health-related Quality of Life also improved over the duration of treatment. A randomized controlled trial (RCT) is needed to demonstrate efficacy of the intervention.

Rates of psychiatric disorders are considerably elevated in young people with long term physical health conditions. Currently few children obtain effective mental health treatments in the context of long term physical health conditions, and ways to improve access to evidence-based mental health interventions are urgently needed. One approach is to deploy briefer, more economical, yet still evidence-based, treatments. The objective of this review was to evaluate the efficacy of brief interventions targeting psychiatric disorders in children and young people with long term physical health conditions.Predefined terms relating to brief psychological interventions for psychiatric disorders in children with long term physical health conditions were used to search relevant databases. A systematic review and meta-analysis was carried out in accordance with the Cochrane guidelines. Two reviewers independently screened titles and abstracts, extracted the data and conducted risk of bias assessments.A total of 12 randomised controlled trials were found to meet the inclusion criteria of the review. Of those, three studies were suitable for meta-analysis. A large effect size in favour of brief cognitive behavioural therapy for anxiety was found (g = - 0.95, CI -1.49 to -0.041; p .001) with non-significant moderate-substantial heterogeneity (IThis review suggests there is preliminary evidence that brief interventions, based on cognitive behavioural principles, may benefit young people with an anxiety disorder in the context of a long term physical health condition. There was insufficient evidence to assess whether this held true for depression and disruptive behaviour.

Background The origins of mental contamination fears are unknown although this might enhance interventions. Method Thirty people with OCD and contamination fears were interviewed about direct, vicarious and informational learning routes to fear, especially mental contamination fears. Results 29 reported contact contamination, 17 mental contamination and 6 morphing fears. Mental contamination fears started around 15.5 years ( SD =7.8). Contact contamination preceded mental contamination in 9 cases, four described simultaneous onset, and two reported mental contamination first. Thirteen participants with mental contamination (76.5%) recalled a direct learning experience, often immoral acts. Three participants with mental contamination fears reported receiving threatening information. Of the 6 with morphing fears, three described a direct learning experience, three reported an occasion when they received threatening information, and one provided an example of a vicarious learning event. Conclusion Contact contamination tends to precede mental contamination and is associated with specific incidents. Mental contamination precedents often involved immoral acts (direct learning) in which the person was the victim or perpetrator. In contrast contact contamination fears showed a more equal distribution of direct, vicarious and informational. This study is limited by a small sample size and retrospective method but provides an initial understanding of the origins of mental contamination.

Background: Little is understood about the relationship between therapist competence and the outcomes of patients treated for common mental health disorders. Furthermore, the evidence is yet to extend to competence in the delivery of low-intensity cognitive behavioural interventions. Understanding this relationship is essential to the dissemination and implementation of low-intensity cognitive behavioural interventions. Aims: The aim of this study was to explore the relationship between Psychological Well-being Practitioner (PWP) competence and patient outcome within the framework of the British government's Improving Access to Psychological Therapies (IAPT) initiative. Method: Forty-seven PWPs treating 3688 patients participated. Relationships between PWP scores on three observed standardized clinical examinations and reliable change in patients’ symptoms of anxiety and depression were explored at two time points: during the year-long training phase, and over a 12-month follow-up. Results: Results indicated that patients treated by qualified PWPs achieved superior outcomes than those treated by trainees. Little support was found for a general association between practitioner competence in delivering low-intensity cognitive behavioural interventions and patient outcome, either during or post-training; however, significantly more patients of the most competent PWPs demonstrated reliable improvement in their symptoms of anxiety and depression than would be expected by chance alone and fewer deteriorated compared with those treated by the least competent PWPs. Conclusion: Results were indicative of a complex, non-linear relationship, with patient outcome affected by PWP status (trainee or qualified) and by competence at its extremes. The implications of these results for the dissemination and implementation of low-intensity cognitive behavioural interventions are discussed.

Background: Perfectionism can become a debilitating condition that may negatively affect functioning in multiple areas, including mental health. Prior research has indicated that internet-based cognitive behavioral therapy can be beneficial, but few studies have included follow-up data. Objective: The objective of this study was to explore the outcomes at follow-up of internet-based cognitive behavioral therapy with guided self-help, delivered as 2 separate randomized controlled trials conducted in Sweden and the United Kingdom. Methods: In total, 120 participants randomly assigned to internet-based cognitive behavioral therapy were included in both intention-to-treat and completer analyses: 78 in the Swedish trial and 62 in the UK trial. The primary outcome measure was the Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale (FMPS CM). Secondary outcome measures varied between the trials and consisted of the Clinical Perfectionism Questionnaire (CPQ; both trials), the 9-item Patient Health Questionnaire (PHQ-9; Swedish trial), the 7-item Generalized Anxiety Disorder scale (GAD-7; Swedish trial), and the 21-item Depression Anxiety Stress Scale (DASS-21; UK trial). Follow-up occurred after 6 months for the UK trial and after 12 months for the Swedish trial. Results: Analysis of covariance revealed a significant difference between pretreatment and follow-up in both studies. Intention-to-treat within-group Cohen d effect sizes were 1.21 (Swedish trial; 95% CI 0.86-1.54) and 1.24 (UK trial; 95% CI 0.85-1.62) for the FMPS CM. Furthermore, 29 (59%; Swedish trial) and 15 (43%; UK trial) of the participants met the criteria for recovery on the FMPS CM. Improvements were also significant for the CPQ, with effect sizes of 1.32 (Swedish trial; 95% CI 0.97-1.66) and 1.49 (UK trial; 95% CI 1.09-1.88); the PHQ-9, effect size 0.60 (95% CI 0.28-0.92); the GAD-7, effect size 0.67 (95% CI 0.34-0.99); and the DASS-21, effect size 0.50 (95% CI 0.13-0.85). Conclusions: The results are promising for the use of internet-based cognitive behavioral therapy as a way of targeting perfectionism, but the findings need to be replicated and include a comparison condition. Funding Agencies|National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London

SummaryObsessive–compulsive disorder (OCD) is one of the most debilitating psychiatric conditions in young people. In DSM-5 it is no longer characterised as an anxiety disorder, but instead is part of a group of ‘obsessive–compulsive and related disorders'. In the past 10 years, cognitive—behavioural therapy (CBT) has become well established as the first-choice treatment. This article explains some of the elements of CBT and describes new directions in research which might improve interventions.

Background Children and young people with chronic neurological conditions have significantly higher rates of mental health disorders than those without a chronic health condition, or those with chronic illnesses that do not involve the CNS. Mental health problems can impact on quality of life as well as on the management and medical consequences of the physical illness yet may be relatively easy to treat. However, such mental health disorders often go unrecognised and therefore untreated. The aim of the current study was to establish the feasibility of routine screening and brief telephone intervention for mental health disorders in paediatric neurology clinics. Methods Parents of children and young people aged 7–18 attending specialist paediatric neurology clinics were asked to complete an online screening questionnaire (the Strengths and Difficulties Questionnaire; SDQ) on a tablet computer in clinic. Those who had symptoms of a mental health disorder were invited to complete a longer online diagnostic questionnaire, the Development and Wellbeing Assessment (DAWBA), at home. Those with impairing symptoms were offered a 10-session guided self-help intervention delivered over the telephone. Standardised measures were completed before, during and after the intervention. Results The method of identification proved feasible in terms of numbers completing the SDQ (n=406, of which n=232 had significant symptoms of a mental health disorder) and DAWBA (n=124). 76% of those completing the DAWBA met DSM-V diagnostic criteria for a mental health disorder. 40 families took part in the brief intervention and results are promising, with progress made towards families chosen goals and high levels of satisfaction reported by families and clinicians. Conclusions Children and young people with chronic neurological conditions have high rates of mental health disorders. These disorders can be detected and treated through a simple online diagnostic tool and telephone intervention and this method is acceptable to families.

Background Generalised anxiety disorder (GAD) is common, causing unpleasant symptoms and impaired functioning. The National Institute for Health and Care Excellence (NICE) guidelines have established good evidence for low-intensity psychological interventions, but a significant number of patients will not respond and require more intensive step 3 interventions, recommended as either high-intensity cognitive behavioural therapy (CBT) or a pharmacological treatment such as sertraline. However, there are no head-to-head comparisons evaluating which is more clinically effective and cost-effective, and current guidelines suggest that treatment choice at step 3 is based mainly on patient preference. Objectives To assess clinical effectiveness and cost-effectiveness at 12 months of treatment with the selective serotonin reuptake inhibitor (SSRI) sertraline compared with CBT for patients with persistent GAD not improved with NICE-defined low-intensity psychological interventions. Design Participant randomised trial comparing treatment with sertraline with high-intensity CBT for patients with GAD who had not responded to low-intensity psychological interventions. Setting Community-based recruitment from local Improving Access to Psychological Therapies (IAPT) services. Four pilot services located in urban, suburban and semirural settings. Participants People considered likely to have GAD and not responding to low-intensity psychological interventions identified at review by IAPT psychological well-being practitioners (PWPs). Those scoring ≥ 10 on the Generalised Anxiety Disorder-7 (GAD-7) anxiety measure were asked to consider involvement in the trial. Inclusion criteria Aged ≥ 18 years, a score of ≥ 10 on the GAD-7, a primary diagnosis of GAD diagnosed on the Mini International Neuropsychiatric Interview questionnaire and failure to respond to NICE-defined low-intensity interventions. Exclusion criteria Inability to participate because of insufficient English or cognitive impairment, current major depression, comorbid anxiety disorder(s) causing greater distress than GAD, significant dependence on alcohol or illicit drugs, comorbid psychotic disorder, received antidepressants in past 8 weeks or high-intensity psychological therapy in previous 6 months and any contraindications to treatment with sertraline. Randomisation Consenting eligible participants randomised via an independent, web-based, computerised system. Interventions (1) The SSRI sertraline prescribed in therapeutic doses by the patient’s general practitioner for 12 months and (2) 14 (± 2) CBT sessions delivered by high-intensity IAPT psychological therapists in accordance with a standardised manual designed for GAD. Main outcome measures The primary outcome was the Hospital Anxiety and Depression Scale – Anxiety component at 12 months. Secondary outcomes included measures of depression, social functioning, comorbid anxiety disorders, patient satisfaction and economic evaluation, collected by postal self-completion questionnaires. Results Only seven internal pilot participants were recruited against a target of 40 participants at 7 months. Far fewer potential participants were identified than anticipated from IAPT services, probably because PWPs rarely considered GAD the main treatment priority. Of those identified, three-quarters declined participation; the majority (30/45) were reluctant to consider the possibility of randomisation to medication. Limitations Poor recruitment was the main limiting factor, and the trial closed prematurely. Conclusions It is unclear how much of the recruitment difficulty was a result of conducting the trial within a psychological therapy service and how much was possibly a result of difficulty identifying participants with primary GAD. Future work It may be easier to answer this important question by recruiting people from primary care rather than from those already engaged in a psychological treatment service. Trial registration Current Controlled Trials ISCRTN14845583. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 45. See the NIHR Journals Library website for further project information.

People with epilepsy are significantly more likely to have a mental health disorder than those without a chronic illness. The reasons for this are multiple but may include the mental health difficulties being perceived as complex due to the presence of a chronic illness. In part due to the apparent complexity of the co-occurring physical and mental illness, many are not offered evidence-based treatment (EBT) for the mental health disorder. There is little guidance to inform clinicians about the interventions to use to treat mental health disorders in people with epilepsy. The present paper reports a case of treatment for depression using a standard EBT in a young person with epilepsy. The patient also had clinically significant symptoms of anxiety and an eating disorder and would be considered ‘complex’ according to standard criteria. The intervention, however, was relatively simple and was delivered as guided self-help via 10 weekly telephone calls of approximately 30 minutes duration, and two follow-up calls at one month and three months post-intervention. Self-report and parent-report questionnaire measures were completed before and after the intervention, and at both follow-up time points. A blind-rated online diagnostic interview measure was also completed before and after the intervention. The young person and her family also completed a qualitative interview of their experiences of the intervention. This simple intervention was effective in working towards the client's goals, although pre–post measurement on standard measures was variable. This interesting case raises questions about whether patients with mental and physical comorbidities are complex, or just perceived as complex.

There has been a recent expansion of interest in the concept of mental contamination. Despite a growing number of experiments and interview-based studies of mental contamination, there is a need for questionnaire-based assessment measures, and for a further understanding of the degree to which mental contamination is related to other aspects of OCD symptomatology and/or to established cognitive constructs relevant to OCD. We assessed the psychometric properties of three new measures of mental contamination (the Vancouver Obsessional Compulsive Inventory – Mental Contamination Scale, the Contamination Sensitivity Scale, and the Contamination Thought-Action Fusion Scale) in participants diagnosed with OCD (n = 57), participants diagnosed with an anxiety disorder other than OCD (n = 24) and in undergraduate student controls (n = 410). For some of these analyses, our OCD sample was subdivided into those with contamination-related symptoms and concerns (n = 30) and those whose OCD excluded concerns related to contamination fear (n = 27). Results showed that the three new scales had excellent psychometric properties, including internal consistency, convergent and divergent validity, and discriminant validity. Further, the new measures accounted for significant unique variance in OCD symptoms over and above that accounted for by depression, anxiety, traditional contact-based contamination, and OCD beliefs. Results are discussed in terms of the clinical utility of the scales, and of the nature of contamination fears in OCD.

Background and objectives Fear of contamination can be evoked following physical contact with a dirty, harmful or polluted item, person, or place (contact contamination) or in the absence of physical contact with a contaminant (mental contamination). The spread of contact contamination does not degrade over successive degrees of removal from the contaminated source. However, to date, the spread of mental contamination has not been empirically investigated. This study aimed to examine the spread and degradation of mental contamination. Methods The paradigm of Tolin et al. (2004) was adapted. Feelings of mental contamination were evoked, and participants were asked to transfer these feelings to an uncontaminated pencil by touching it (contact condition) and without touching it (no contact condition). Results Seventy-two percent of participants in the contact condition and 48% participants in the no-contact condition reported being able to transfer contamination to a clean pencil, demonstrating that mental contamination transfers both with and without contact. In both conditions, the mental contamination subsequently spread to a series of 12 neutral pencils without degradation. Conclusions These findings suggest that mental contamination can be transmitted and spread in the absence of physical contact, similar to contact contamination.

Being highly attentive to details can be a positive feature. However, for some individuals, perfectionism can lead to distress and is associated with many psychiatric disorders. Cognitive behavior therapy has been shown to yield many benefits for those experiencing problems with perfectionism, but the access to evidence-based care is limited. The current study investigated the efficacy of guided Internet-based Cognitive Behavior Therapy (ICBT) and predictors of treatment outcome. In total, 156 individuals were included and randomized to an eight-week treatment or wait-list control. Self-report measures of perfectionism, depression, anxiety, self-criticism, self-compassion, and quality of life were distributed during screening and at post-treatment. Intention-to-treat were used for all statistical analyses. Moderate to large between-group effect sizes were obtained for the primary outcome measures, Frost Multidimensional Perfectionism Scale, subscales Concerns over Mistakes and Personal Standards, Cohen's d = 0.68–1.00, 95% Confidence Interval (CI) [0.36–1.33], with 35 (44.9%) of the patients in treatment being improved. Predictors were also explored, but none were related to treatment outcome. In sum, guided ICBT can be helpful for addressing problems with clinical perfectionism, but research of its long-term benefits is warranted.

Background: A large body of research has identified that many therapists do not use research to inform their practice, but few studies investigate the reasons behind this. Aims: The current study seeks to understand what sources therapists use to inform their practice and why they are chosen. Method: Thirty-three interviews with psychological therapists in the UK were undertaken. These were transcribed and analysed using Interpretative Phenomenological Analysis. Results: Two superordinate themes emerged. The former focused on the nature of evidence and the latter described why certain sources were used to make clinical decisions. When discussing evidence, participants felt that research studies, specifically Randomized Controlled Trials (RCTs), used unrepresentative samples. Therapists felt that research other than RCTs, particularly qualitative research, was important. Therapist specific factors were felt to be as, or more, important than the technique used to treat patients. When discussing the sources they used, therapists preferred to use their clinical experience or their patients’ experience to make clinical decisions. Theoretical or practical information was preferred to empirical research. The presentation of information was felt to be important to encourage the implementation of research, and therapists also felt tools such as outcome measures and manuals were too rigid to be useful. Finally, patients’ choice of treatment was felt to be important in treatment decisions. Conclusions: The views of therapists were heterogeneous, but this study highlighted some of the barriers to closing the gap between science and practice. This knowledge can be used to increase the translation of science into practice.

Objectives Intrusive imagery is hypothesised to evoke feelings of contamination and urges to wash. This study aimed to (1) develop a questionnaire to assess imagery associated with contamination fears; and (2) compare contamination imagery in a sample of people with contamination based obsessive–compulsive disorder (C-OCD) with a non-clinical student sample. Methods Non-clinical students ( n =45) and people with C-OCD and contamination fears ( n =45) completed a self-report questionnaire designed to assess images associated with contamination. Results Compared to non-clinical participants, people with C-OCD reported images associated with contamination that were more vivid, harder to dismiss and distressing. Participants with contamination fears reported images that directly evoked feelings of dirtiness and triggered compulsive washing behaviours. A small number of participants reported beneficial images that reduced feelings of contamination. Conclusions These preliminary findings indicate that imagery can evoke feelings of contamination. However, future research is needed to establish the nature and causative role of imagery in mental contamination. Questionnaire methods may be useful for clinical assessment of imagery associated with contamination fears.

Background The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines. Method Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7). Results Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff. Conclusions Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery., Highlights • We studied clinical outcomes in 19,395 patients who completed treatment in year one of the IAPT programme. • Overall 40.3% of patients showed reliable recovery, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. • Considerable between service variability in outcomes was observed. • Several service and patient level predictors of outcome were identified. • Compliance with NICE treatment guidelines was associated with improved outcomes.

Background: Patients with anxiety disorder diagnoses commonly have more than one anxiety diagnosis. While cognitive-behavioural interventions have proven efficacy in treating single anxiety disorder diagnoses, there has been little investigation of their efficacy in treating co-occurring anxiety disorders. Aims: To evaluate the efficacy of a transdiagnostic cognitive-behavioural intervention for treating co-occurring anxiety disorders. Method: An A-B single case study design (N = 6) was used to evaluate the efficacy of a 12 to 13-session modular transdiagnostic cognitive-behavioural intervention for treating co-occurring anxiety disorders across patients with at least two of the following diagnoses: GAD, Social Phobia, Panic Disorder and/or OCD. Results: Five of the six participants completed treatment. At posttreatment assessment the five treatment completers achieved diagnostic and symptomatic change, with three participants being diagnosis free. All participants who completed treatment no longer met criteria for any DSM-IV-TR Axis-I diagnosis at the 3-month follow-up assessment, and demonstrated reliable and clinically-significant improvements in symptoms. Across the participants, statistically significant improvements from pre to postintervention were found on measures of anxiety, depression and general well-being, and all improvements were maintained at 3-month follow-up. Conclusions: Results suggest that transdiagnostic cognitive behavioural interventions can be of benefit to patients with co-occurring anxiety disorders.

Background: It was recently proposed that feelings of dirtiness and pollution can arise in the absence of physical contact with a contaminant. At present, there is limited data regarding the qualitative features of this construct of “mental contamination”, although it is hypothesized to be particularly relevant to Obsessive Compulsive Disorder (OCD), where compulsive washing in response to contamination fear is a common symptom presentation (Rachman, 2006). Aims and method: The aim of this research was to explore the qualitative features of mental contamination in 20 people with contamination-based OCD, using a semi-structured interview. Results: All participants reported times when they had felt dirty or contaminated in the absence of physical contact with a dirty or dangerous object. Mental contamination generated diffuse feelings of internal dirtiness not localized to the hands, which evoked urges to wash (100% participants), neutralize (80% participants) and avoid (85% participants). Conclusions: In support of the theory outlined by Rachman (2006), mental contamination was found to take a number of forms, be primarily associated with a human source, generate internal dirtiness and cause emotional distress and urge to wash. The clinical implications of these findings are discussed and ideas for future research are proposed.