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The recent NICE depression guidelines recommend that cognitive-behavioural and interpersonal psychotherapies should be the treatments of choice for child or adolescent depression. This paper argues that in so doing, NICE goes beyond the evidence adduced and judges too much relevant data ineligible. This is likely to be due to a methodology developed for biomedicine, where NICE-eligible data are substantial. Consequently, NICE risks distorting practice in a small specialty where randomised controlled trials are comparatively rare and usually involve small samples.

Resumen En este trabajo nos proponemos describir algunas de las causas que llevan a Aaron T. Beck a abandonar el psicoanálisis y a participar de la creación de la terapia cognitiva. Para ello, describiremos los trabajos de investigación desarrollados por Beck entre los años 1959 y 1962. En ellos se empiezan a procesar los datos que darán lugar a la caída de la hipótesis explicativa psicoanalítica de la depresión. Dentro de este análisis incluiremos algunos elementos que consideramos esenciales para entender este proceso de cambio: la obtención de un subsidio para investigar la depresión y la aparición de colaboradores como Marvin Hurvich y Seygmour Feshbach, cuyas nuevas herramientas y metodologías ayudaron a Beck a poner a prueba la hipótesis psicoanalítica de la depresión. Por último, incluiremos cuestiones referidas a las políticas de investigación del Instituto Nacional de Salud Mental, así como motivos personales y de la política institucional. Résumé Cet article a l’objectif de décrire quelques-unes des causes qui mènent Aaron T. Beck à abandonner le psychanalyse et de participer à la création de la thérapie cognitive. Avec cet intérêt, l’article explore ce travail de recherche développé par Beck entre les années 1959 et 1962. Dans cette période, se commencent à traiter les données qui mèneront à la chute de l’hypothèse explicative psychanalytique de la dépression. Dans cette analyse l’article inclut certains éléments que nous considérons essentiels afin de comprendre ce processus de changement : l’obtention d’une subvention pour étudier la dépression et l’entrée en scène de collaborateurs comme Marvin Hurvich et Seymour Feshbach, qui ont apporté de nouveaux outils et méthodologies pour tester l’hypothèse psychanalytique de la dépression. Enfin, nous allons inclure des questions liées à la recherche sur les politiques à l’Institut National de la Santé Mentale, ainsi que des raisons personnelles et de la politique institutionnelle. Resumo Neste trabalho, descrevemos algumas das causas que levam Aaron T. Beck a abandonar a psicanálise e participar da criação da terapia cognitiva. Com este objetivo, vamos descrever os trabalhos de investigação desenvolvidos por Beck entre 1959 e 1962, quando começa a processar os dados que derrubarão a hipótese explicativa psicanalítica da depressão. Nesta análise, incluiremos alguns elementos que consideramos essenciais para entender esse processo de mudança: a obtenção de um subsídio para pesquisar a depressão e a presença de colaboradores como Marvin Hurvich e Seygmour Feshbach, cujas novas ferramentas e metodologias ajudaram Beck a testar a hipótese psicanalítica da depressão. Por último, incluiremos questões que se referem às políticas de investigação do Instituto Nacional de Saúde Mental, assim como motivos pessoais e de política institucional. Abstract In this study we describe some of the reasons that lead Aaron T Beck to move away from psychoanalysis and participate in the creation of cognitive therapy. With this aim in view, we describe the research developed by Beck between 1959 and 1962. In these studies the data that promotes the fall of the psychoanalytic explanatory hypothesis for depression began to be processed. Within this analysis we include some elements that we consider essential to understand this process of change: From Beck´s obtaining a grant to investigate depression and his starting to work with collaborators like Marvin Hurvich and Sigmour Feshbach, whose new tools and methodologies helped Beck to test a psychoanalytic hypothesis of depression. Finally, we will include questions related to the research policies of the National Institute of Mental Health, and some commentaries about personal and institutional policy reasons that influenced Beck’s work.

Objective To develop and evaluate a simplified and condensed cognitive behavioral treatment for bulimia nervosa suitable for use in primary care. Method: Once developed, the treatment was tested on a consecutive series of 11 patients. Results: Six patients did well, 3 were nonresponders, and in the other 2 external events interfered with progress. Discussion: This form of treatment may benefit a significant proportion of those patients with bulimia nervosa who are seen in primary care. It can be administered by nonspecialist therapists. © 1996 by John Wiley & Sons, Inc.

Anorexia nervosa (AN) is a serious psychiatric disorder that often follows a protracted course, and continues to confound those who attempt treatment once the patient has reached adulthood. Several randomized clinical trials for adults with AN have tested well-known therapies such as cognitive behavior therapy, supportive psychotherapies, or focal psychodynamic therapy, all of which have delivered frustratingly few helpful treatment strategies. Perhaps a different path could be pursued where we do not aim to cure all patients with 1 or 2 of these well-trodden therapies. Instead, a more targeted alternative, testing several novel approaches, could collectively reach a larger cohort of patients suffering from AN, the most lethal of all psychiatric disorders. (PsycINFO Database Record

Sudden gains are abrupt and substantial improvements in symptoms. This study used the Outcome Questionnaire-45 (OQ-45; Lambert et al., 1996) to characterize sudden gains occurring in a cognitive-behavioral therapy training clinic. Also, gradual gainers were identified and used as a comparison group. Sudden gains were identified in 23% of patients and in 29% of those who entered treatment in the clinical range on the OQ, within the range of prevalence established by previous sudden gain studies in the context of randomized controlled trials (RCT's). As in earlier research, sudden gains tended to occur early in therapy. However, sudden gains were more likely to be reversed than in RCT's. Gradual gains occurred for 54% of nonsudden gainers; they were of similar magnitude to sudden gains but occurred later in therapy. Sudden gainers showed significantly better outcomes at the end of treatment than did gradual gainers. Sudden gains have clear prognostic significance, but more research is needed to determine why they may be more transient in naturalistic studies or studies involving less experienced therapists than they are in RCT's.

Nightmares are a common feature of posttraumatic stress disorder (PTSD) and are frequently resistant to treatment. Two emerging treatments for nightmares are pharmacotherapy with prazosin and psychotherapy using imagery rehearsal (IR). A case illustration demonstrates the application of these treatments with a client suffering from chronic, severe PTSD. The case illustrates the use of these strategies for managing PTSD-related nightmares, as well as the novel approach of scheduled awakenings following relapse.

Japanese Morita therapy is one of the few influential Eastern therapeutic approaches that has drawn attention in the realm of counseling and psychotherapy in Western societies over the last several decades. Notwithstanding such recognition, Morita therapy is still relatively unknown to many scholars, researchers, and practitioners in the helping profession in the West, and its therapeutic usefulness remains to be fully explored. This article seeks to provide a brief overview of Morita therapy and examines its implications for helping clients deal with the issue of social anxiety in particular.

Contains fulltext : 89723.pdf (Publisher’s version ) (Closed access) BACKGROUND: Cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) can decrease the level of fatigue and disabilities, but it has been suggested that during therapy some patients experience a deterioration of their symptoms rather than an improvement. The aim of this study is to examine the frequency and severity of symptom deterioration during CBT for CFS. METHODS: Data from 3 randomised controlled trials on CBT for CFS were pooled and reanalysed. Symptom deterioration during the trial was rated by patients and measured as deterioration in fatigue, pain, functional impairment and psychological distress. Both the frequency and severity of deterioration in these domains were compared between the patients receiving CBT and those in the control group. Predictors of symptom deterioration were identified by comparing their means in patients with and without an increase in fatigue. Statistically significant predictors were then combined in a logistic regression model. RESULTS: The frequency of symptom deterioration varied from 2 to 12% in patients receiving CBT and from 7 to 17% in the control group. None of the measures showed a significantly higher frequency of symptom deterioration in the CBT group. The severity of deterioration was also comparable in the CBT and in the control group. No predictors of symptom deterioration specific to CBT were found. CONCLUSION: Patients receiving CBT do not experience more frequent or more severe symptom deterioration than untreated patients. The reported deterioration during CBT seems to reflect the natural variation in symptoms. Thus, CBT is not only a helpful, but also a safe treatment for CFS. 01 juni 2010

Resume Les depressions severes, dans leur phase aigue, rendent difficile la psychotherapie, du fait du handicap lie notamment aux troubles cognitifs et motivationnels. Mais elles representent un enjeu important en phase post-processuelle pour la prevention des rechutes. Les therapies cognitives et comportementales (TCC) et, a un degre moindre de preuves, la therapie cognitive basee sur la pleine conscience (TCPC) y ont fait la demonstration de leur efficacite. De maniere plus experimentale, le courant de la psychologie positive (PP) incarne peut-etre un nouveau courant de ressources (travail sur l’optimisme, le lien social, l’equilibre emotionnel…) pour la prevention des rechutes chez ces patients vulnerables.

Resume Plusieurs etudes ont montre l’efficacite de l’utilisation de la mindfulness based cognitive therapy (MBCT) dans la prevention des rechutes depressives chez le patient non bipolaire (Segal et al. [2001]), puis d’autres travaux ont explore les effets de cette approche sur les ruminations du sujet depressif (Teasdale [2000] ; Watkins, Teasdale, 2001). Cette etude pilote est la premiere qui inclut exclusivement des patients bipolaires I repartis en trois groupes qui ont beneficie du programme MBCT en huit seances. Tous ces patients avaient suivi au prealable le programme de therapie comportementale et cognitive (TCC) de groupe pour bipolaires (modele de Lam). Cette etude clinique et psychologique montre la faisabilite du programme, sa bonne acceptation par les sujets, avec une tendance a l’augmentation de la capacite de pleine conscience relative a l’assiduite de la demarche.

Psychophysiological factors in maintaining tinnitus-related distress have been emphasized in current tinnitus models. Hyperreactivity in the autonomous nervous system is supposed to hinder habituation processes and might contribute to maladjustment to tinnitus symptoms in the long run. Accordingly, biofeedback treatment targeting physiological activity ought to reduce tinnitus annoyance and facilitate habituation.One hundred and thirty patients completed a manual-based psychological treatment especially developed for chronic tinnitus sufferers. A subsample consisting of 67 participants were randomly assigned to a waiting list (3 months) and served as a control group. The programme consisted of 15 sessions of cognitive-behavioural therapy combined with a psychophysiological treatment using a biofeedback approach.Different muscle regions of the head and neck and skin conductance level were assessed with biofeedback equipment. Physiological treatment effects were analysed using the pre-post effect sizes in comparison to the wait list group. Correlations for physiological changes and psychological treatment effects were computed.Moderate to large effect sizes for physiological changes were demonstrated. Physiological and psychological treatment effects were found to be unrelated.Our treatment approach, which combined biofeedback therapy with CBT elements, was found to be highly effective in reducing psychophysiological activation. Psychological and physiological variables seem to represent independent response systems.

Background: There are now a substantial number of controlled trials investigating the efficacy of acceptance and commitment therapy (ACT). This meta-analysis combined multiple well-controlled studies to help clarify the overall impact of ACT relative to waiting lists, psychological placebos, treatment as usual, and established therapies. Method: A comprehensive literature search produced 18 randomized controlled trials (n = 917) that were included in the final analyses. Effect size was computed with Hedges’s g which can be interpreted with Cohen’s convention of small (0.2), medium (0.5), and large (0.8) effects. Results: There was a clear overall advantage of ACT compared to control conditions (effect size = 0.42). The average ACT-treated participant was more improved than 66% of the participants in the control conditions. Analyzed separately ACT was superior to waiting lists and psychological placebos (effect size = 0.68) and treatment as usual (effect size = 0.42). However, ACT was not significantly more effective than established treatments (effect size = 0.18, p = 0.13). Also, ACT was not superior to control conditions for the distress problems (anxiety/depression: effect size = 0.03, p = 0.84). Conclusions: The results reveal that ACT is more effective than control conditions for several problem domains, but there is no evidence yet that ACT is more effective than established treatments.

This article reviews the empirical literature related to the use of computer-administered, cognitive-behaviorally based assessment and treatment for obsessive-compulsive disorder (OCD). Such research has increased steadily over the years, and has shown that treatments such as BT STEPS are effective at both assessing for and treating OCD. More large-scale studies examining the utility of such programs are needed, but initial research shows moderate to large effect sizes for reduction of OCD symptoms and impairment in functioning. The article concludes with recommendations for future directions for both clinical work and research in this area, including expansion of such services to assist in gaining more knowledge of how effective such treatments are, expand the number of people who could benefit from receiving such services, and examining the use of computers in treatments for other anxiety disorders to suggest new ways to move forward with OCD treatment.

This paper evaluates the effectiveness of group cognitive behaviour therapy (GCBT) as an intervention for unipolar depressive disorders. PsychINFO and PubMed databases were selected to generate the 34 papers used for this review. Our results showed that effect sizes for GCBT over the control conditions range from small (0.1) to large (2.87) with the mean effect size of 1.10. The pre-post treatment effect sizes for GCBT range from 0.30 to 3.72 with a mean of 1.30. Convergent evidence was demonstrated across different outcome measures of GCBT. Our findings indicated that GCBT yielded outcomes better than no-treatment controls and was comparable with other treatments (including both bona fide and non-bona fide comparison treatments). It was concluded that GCBT was effective for the treatment of Unipolar depression and thus can be used with confidence. There is now an urgent need to develop and evaluate a coherent GCBT theory, in particular the roles of group processes in GCBT, before further major advancement in this area can be made.

Rehabilitation from a mental or physical disorder can become complicated when patients feel overwhelmed by symptoms and unable to make progress. Newer behavioral approaches have been developed that can help these patients. This article describes behavioral activation techniques designed to address depression.

To explicate differences between early and recent meta-analytic estimates of the effects of cognitive-behavioral therapy (CBT) for adolescent depression.Meta-analytic procedures were used to investigate whether methodological characteristics moderated mean effect sizes among 11 randomized, controlled trials of CBT focusing on adolescents meeting diagnostic criteria for unipolar depression.Cumulative meta-analyses indicated that effects of CBT have decreased from large effects in early trials, and confidence intervals have become narrower. Effect sizes were significantly smaller among studies that used intent-to-treat analytic strategies, compared CBT to active treatments, were conducted in clinical settings, and featured greater methodological rigor based on CONSORT (Consolidated Standards of Reporting Trials) criteria. The mean posttreatment effect size of 0.53 was statistically significant.Differences in estimates of the efficacy of CBT for depressed adolescents may stem from methodological differences between early and more recent investigations. Overall, results support the effectiveness of CBT for the treatment of adolescent depression.

Vulvar vestibulitis is a frequently occurring syndrome and a major cause of personal and marital difficulties. Effective management requires a thorough understanding of the mechanisms that lead to the disorder. We advocate taking in an integrated psychological and physical approach.

Background: Training patients in structured problem solving strategies is one of the oldest cognitive behavioural therapy methods. Recent social, psychological and neuropsychiatric research provides a multifactorial rationale for methods that strengthen patients' ability to carry out stepwise problem solving in their real life problems.Aim: This paper reviews the rationale for Problem Solving Training with reference to recent biomedical and psychosocial research and describes several preliminary studies of its benefits.Method: A four-phase programme of 24 weekly or bi-weekly lessons in small groups begins with patient's pratical everyday problems before moving to gradually more complex and emotionally charged interpersonal, personal and crisis issues in an attempt to restore generic problem solving abilities and improve long-term recovery from schizophrenia.Results: Preliminary outcome studies show promising outcomes on a reduction in rehospitalizations as well as clinical, social and neurocognitive measu...

Contains fulltext : 51742.pdf (Publisher’s version ) (Closed access) BACKGROUND: Cognitive behavioural therapy (CBT) for chronic fatigue syndrome (CFS) leads to a decrease in symptoms and disabilities. There is controversy about the nature of the change following treatment; some suggest that patients improve by learning to adapt to a chronic condition, others think that recovery is possible. The objective of this study was to find out whether recovery from CFS is possible after CBT. METHODS: The outcome of a cohort of 96 patients treated for CFS with CBT was studied. The definition of recovery was based on the absence of the criteria for CFS set up by the Center for Disease Control (CDC), but also took into account the perception of the patients' fatigue and their own health. Data from healthy population norms were used in calculating conservative thresholds for recovery. RESULTS: After treatment, 69% of the patients no longer met the CDC criteria for CFS. The percentage of recovered patients depended on the criteria used for recovery. Using the most comprehensive definition of recovery, 23% of the patients fully recovered. Fewer patients with a co-morbid medical condition recovered. CONCLUSION: Significant improvement following CBT is probable and a full recovery is possible. Sharing this information with patients can raise the expectations of the treatment, which may enhance outcomes without raising false hopes.

The author discusses three aspects of rational emotive behavior therapy (REBT) that occasionally make him wince. They are: REBT does not adequately address issues relating to diversity-sensitive counseling; there is a tendency for some REBT adherents to display poor interpersonel skills, and lack a philosophical commitment to the interdependence of humans on one another; and, there is a tendency for REBT to promise more than it can deliver. A list of 15 recommendations and wishes for a “new and improved” version of REBT are included.

Many therapists who subscribe to RET are converts from other approaches. Few master’s or doctoral training programs exclusively teach RET and many do not place any emphasis on it at all. Thus, many otherwise experienced therapists are novices when it comes to integrating RET techniques into their professional repertoire of interventions. And as novices, they experience many of the doubts and obstacles in trying something new. I am such a novice. My formal training in RET consists solely of a Five Day Intensive Practicum (Weinrach, 1977) conducted by Ellis and his staff in 1976 since neither my master’s nor doctoral programs paid much attention to this approach. It has taken me 4 years to feel secure enough to call myself a Rational Therapist. My reluctance was not a philosophical one. Philosophically, I’ve been there for a long time. But I have found it difficult to integrate various RET interventions into my counseling style and feel comfortable at the same time. The discomfort I experienced is similar to what my counselor-trainees experience during their first few years after training with me and my colleagues. It takes a while for a therapist to develop an internally consistent style apart from the role models experienced while in training. Many of the obstacles that I have encountered are probably rather common and especially so for those whose training has been limited to a Five Day Intensive Practicum in RET or less. Those with more formal training have probably dealt with these and similar issues within

The purpose of this paper is to outline a thematic approach to the clinical treatment of clients who have experienced racial trauma. Using the literature on trauma and racist incidents, the authors...

This descriptive and comparative study employed a Q-sort process to describe common factors of therapy in two group therapies for inpatients with chronic mental illness. While pharmacological treatments for chronic mental illness are prominent, there is growing evidence that cognitive therapy is also efficacious. Groups examined were part of a larger study comparing the added benefits of cognitive versus supportive group therapy to the treatment milieu. In general, items described the therapist's attitudes and behaviors, the participants' attitudes and behaviors, or the group interactions. Results present items that were most and least characteristic of each therapy and items that discriminate between the two modalities. Therapists in both groups demonstrated good therapy skills. However, the cognitive group was described as being more motivated and active than the supportive group, indicating that the groups differed in terms of common as well as specific factors of treatment.

Resume Nous presentons ici le cas d’une patiente souffrant du trouble d’anxiete generalisee (TAG) a un degre severe et beneficiant d’un traitement cognitivo-comportemental developpe par notre equipe. Ce traitement valide empiriquement cible les 4 facteurs de notre modele identifies comme etant relies au TAG: l’intolerance a l’incertitude, la surestimation de l’utilite de s’inquieter, les difficultes de resolution de problemes et l’evitement cognitif. Les strategies therapeutiques utilisees y sont decrites: modification de l’intolerance a l’incertitude, reevaluation de l’utilite de s’inquieter, entrainement a la resolution de problemes et exposition cognitive. Nous soulignons l’importance de l’application flexible du protocole de traitement.

Teasdale, Segal and Williams (2003) present the combination of mindfulness and cognitive-behavioural therapy as “one of the most exciting and potentially productive avenues for future exploration.” (p. 160). In the same paper they also recommend moving beyond the current general-purpose, non-case-specific applications of mindfulness (p. 157). By integrating mindfulness interventions more closely with cognitive behavioural theories, clinicians should be in a better position to administer tailor-made mindfulness-based interventions in response to specific case formulations. This paper examines important similarities and differences between mindfulness and Rational-Emotive Behaviour Therapy (REBT), in view of integrating the two practices closely within a one-on-one counselling environment. The latter half of the paper then presents recommendations of how such integration might be achieved in practice. This is illustrated with examples of three new interventions that combine mindfulness with three specific t...

This article describes the unorthodox, but successful treatment of a 32-year-old male client suffering from chronic obsessive-compulsive disorder (OCD). The client was first diagnosed with OCD at age 18, and since then had received all of the standard treatments (both therapeutic and pharmacological) for OCD without showing any improvement. The treatment described here focused on alleviating the client's symptoms of depression, forcefully discouraging the client's talk about his OCD symptoms, and behavioral assignments derived from systemic-constructivist theory. Decisions made by the therapist at various stages of treatment were based on several well-known marriage and family therapy techniques.

Generally, the suppression of unwanted thoughts is found to be ineffective. Moreover, in the longer run, suppression attempts may backfire in that they produce a delayed increase in unwanted thoughts (i.e. a rebound effect). This ineffectiveness and paradox have been observed in various studies, and with various targets, such as neutral thoughts, obsessive intrusions, worries, addictive urges, and phobia-related cognitions. The present study sought to explore the effect of suppression of a different intrusion, namely a hallucination. Healthy undergraduates were exposed to a laboratory procedure that was to provoke hallucinations. Half of the participants were additionally given instructions to suppress the hallucinations. Results indicated that suppression was somewhat effective in the short run, but ineffective in the long run. However, no rebound effect was observed.

The National Institute for Clinical Excellence recently published their guidelines on the treatment of depression in children and young people. This article critically reviews these guidelines in terms of their likely impact on BABCP members and the services in which they work. The evidence base that underpins the guideline is very sparse. There is particularly limited information on which to base guidance to therapists working with younger children. The use that has been made of this evidence is discussed, and some controversial interpretations are criticized. Implications for services and therapists are outlined. In particular, attention is drawn to the pressing need for very substantial additional training if the guidelines are to be implemented correctly. Some suggestions for deployment of staff with differing levels of knowledge and expertise in CBT are offered. Finally, challenges for the field as a whole are discussed. In particular, a great deal more research is needed into the effectiveness of psychological therapies versus wait list and versus each other and medications, and into the levels of training required to provide competent CBT to children and adolescents.

Background: The goal of this pilot study was to evaluate the effects of the cognitive-restructuring technique ‘lucid dreaming treatment’ (LDT) on chronic nightmares. Becoming lucid (realizing that one is dreaming) during a nightmare allows one to alter the nightmare storyline during the nightmare itself. Methods: After having filled out a sleep and a posttraumatic stress disorder questionnaire, 23 nightmare sufferers were randomly divided into 3 groups; 8 participants received one 2-hour individual LDT session, 8 participants received one 2-hour group LDT session, and 7 participants were placed on the waiting list. LDT consisted of exposure, mastery, and lucidity exercises. Participants filled out the same questionnaires 12 weeks after the intervention (follow-up). Results: At follow-up the nightmare frequency of both treatment groups had decreased. There were no significant changes in sleep quality and posttraumatic stress disorder symptom severity. Lucidity was not necessary for a reduction in nightmare frequency. Conclusions: LDT seems effective in reducing nightmare frequency, although the primary therapeutic component (i.e. exposure, mastery, or lucidity) remains unclear.

This paper is intended to contribute to the current debate in relation to persistent stuttering and evidence-based clinical practice.The paper will describe the authors' intervention framework for persistent stuttering, which is guided by evidence from the fields of stuttering and clinical psychology. It supports the opinion that the components of therapy should be grounded in empirically based theories that offer an explanation for the nature of stuttering, its persistence and its individual complexity. It will argue that the goals of therapy should reflect the client's personal values and experience of stuttering, as well as the knowledge and skills of the therapist.The paper maintains that therapy for this disorder needs to account for the highly individual nature of the overt and covert dimensions of persistent stuttering and identify the formal and informal methods that measure progress and outcome. Current research and future directions will be touched on briefly.

This paper illustrates the potential uses of poetry therapy for practitioners interested in cognitively based psychotherapies. Separate brief discussions of cognitive therapy and the uses of poetry and poetry therapy are presented. The congruence between these two approaches is addressed. Sample exercises and poems as illustrations are presented that demonstrate this congruence.

A specific type of social phobia – dictation phobia – was the main and unusual treatment problem in the cognitive-behavioural therapy for an 11-year-old schoolboy. For case formulation and treatment rationale, the social phobia model by Clark and Wells was used. The posttreatment assessment revealed clear positive treatment effects with respect to school grades, social anxiety and overall functioning. The model's applicability for children and adolescents is discussed.

In the UK, recent guidelines on the treatment of depression and anxiety recommend CBT-based self-help materials as one important component of services. However, despite being based on specific CBT techniques or “empirically grounded interventions”, early optimism has been dented by data from recent studies that have cast doubt on the effectiveness of the current generation of these materials. As a consequence, it may be necessary to consider that other factors may contribute to the overall magnitude of CBT effects. Indeed, it is logically inconsistent to argue that specific factors are pre-eminent in CBT whilst maintaining that delivery via therapists is more likely to be effective than self-help. The contribution of “common factors” that operate in personal therapeutic encounters, for example, therapist responsiveness and the patient-therapist alliance, may be one possible overlooked reason for the reduced ef-fectiveness of self-help materials. The development of the next generation of self-help materials, therefore, may benefit from the testing of materials that combine common and specific factors, including specific measurement of the strength of common factors and their relationship to clinical outcomes. We discuss a model of such common factors and suggest how they could be incorporated into the next generation of CBT based self-help materials.

This article reviews the types of adjustments needed to an adult protocol of cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) to make it more acceptable to an adolescent population. Employing developmental principles as well as clinical experience as guidelines, these modifications include the involvement of parents, recognition of the interaction of treatment with normal adolescent developmental tasks, and allowances for typical cognitive and emotional immaturity on treatment procedures. Outcomes from a series of adolescents with BN who were treated with this modified-CBT approach show results similar to those expected in adult populations treated using CBT.

Resume La realite psychique n'est plus a la mode. Les therapies inspirees de l'hypnose ou de la theorie de l'apprentissage sont seules considerees valides. La psychanalyse devrait etudier leur fonctionnement pour eclairer leurs modes d'action.

Rational-Emotive Behavior Therapy (REBT) is a pioneering form of Cognitive Behavior Therapy (CBT). Acceptance and Commitment Therapy (ACT) is part of the new wave of CBTs. In this article, I discuss the papers of Ciarrochi, Robb, and Godsell, and of Ciarrochi and Robb, who propose that REBT and ACT can be quite suitably integrated, and the paper of Steven Hayes, the originator of ACT and of Relational Frame Theory, who is skeptical about the feasibility of Ciarrochi, Robb, and Godsell’s proposals. My own view is that ACT and REBT significantly overlap in their theory and practice and that they can be successfully integrated if both therapies make some changes.

The aim of this article is to consider the current and likely future status of cognitive behaviour therapy (CBT) for disturbed children and adolescents. Two definitions of CBT, narrow and broad, are provided and their core components described. Subsequently the historical development of these therapies and their reception by psychotherapists with different orientations is discussed. Assessment and therapeutic CBT approaches are described and the strength of the evidence for their use is briefly reviewed. Finally the challenges these therapies are currently meeting that might enhance or diminish their value are outlined. It is concluded that CBTs offer a most promising approach in the child and adolescent field and are likely to establish and maintain an important place in the therapeutic armoury of the next generation of professionals concerned to help children and young people with psychiatric disorders.

The authors describe a three-phase sequential integrative model for the psychotherapy of complex posttraumatic self-dysregulation: Phase 1 (alliance formation and stabilization), Phase 2 (trauma processing), and Phase 3 (functional reintegration). The technical precautions designed to maximize safety, trauma processing, and reintegration regardless of the specific treatment approach are discussed. Existing and emerging treatment models that address posttraumatic dysregulation of consciousness, bodily functioning, emotion, and interpersonal attachments are also described. The authors conclude with suggestions for further clinical innovation and research evaluation of therapeutic models that can enhance the treatment of PTSD by addressing complex posttraumatic self-dysregulation.

The UK Department of Health states that there is suggestive, although not conclusive, evidence for the efficacy of cognitive behavioural therapy (CBT) in irritable bowel syndrome (IBS) and that CBT should be considered as a treatment option for the syndrome. This paper provides a general introduction to CBT, the principles which underlie it and how they can be applied to IBS. The components of CBT for IBS are described in some detail. Guidelines for gastroenterologists are provided on how these principles can be used to inform their practice and the existing outcome data are reviewed.

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) project will provide symptomatic and functional outcome data to evaluate the theoretical principles and clinical beliefs that currently guide the treatment of nonpsychotic major depression. Cognitive Therapy (CT) for depression has been chosen as a switch or augmentation treatment for patients who have failed an adequate trial of the antidepressant citalopram. We describe the rationale, organization, and role of CT in STAR*D. We discuss the issues involved in developing and implementing CT in a large, multisite, effectiveness study: therapist selection, training, certification, quality assurance, and post-training supervision. We conclude with a discussion of the implications of our implementation procedures on interpreting the results of the STAR*D study.

This is the third in a series of three papers on cognitive therapy formulation with older people. The aims of this paper are to identify barriers to collaborative conceptualization, and to summarize useful strategies for overcoming these barriers. Obstacles to collaborative conceptualization with older clients have previously been thought of as a consequence of a-e-related skills deficits. In this paper we focus instead on the barriers created by therapist and client-held prejudicial beliefs. A social cognitive perspective is used to conceptualize stereotypical prejudices. Strategies are described for challenging or reframing prejudicial beliefs. and addressing the mechanisms that perpetuate these beliefs.

The Cognitive Therapy Scale (CTS) has been widely used in cognitive therapy training Centers to assess therapist competence but competence has not previously been clearly shown to be associated with cognitive therapy outcome, possibly because an insufficient range of competence has been sampled. Competence was compared with alliance as process variables that might relate to change in therapy. A randomly selected therapy session from each of 30 courses of cognitive therapy for depression was rated using the CTS. Both therapeutic alliance and therapist competence were related to outcome. In regression analyses, the alliance remained significantly related to outcome when controlling for competence, but not vice versa. These relationships with outcome were primarily attributable to therapists rather than to clients. Associations with outcome appeared stronger for clients who completed therapy than for those who did not. These findings suggest that measurable factors both common to diverse treatments methods and specific to particular methods should be included in efforts to account for therapy outcome.

Thirty-one community-residing older adults age 60 or over either received 16 sessions of individual cognitive psychotherapy (Beck, Rush, Shaw, & Emery, 1979) or read Feeling Good (Burns, 1980) for bibliotherapy. Posttreatment comparisons with the delayed-treatment control indicated that both treatments were superior to a delayed-treatment control. Individual psychotherapy was superior to bibliotherapy at posttreatment on self-reported depression, but there were no differences on clinician-rated depression. Further, bibliotherapy participants continued to improve after posttreatment, and there were no differences between treatments at 3-month follow-up. Results suggest that bibliotherapy and that individual psychotherapy are both viable treatment options for depression in older adults.

This paper discusses and illustrates three evidence-based clinical strategies that could be used to work with modifying clients’ dysfunctional thoughts. An effective strategy in shifting the client's dysfunctional thought is to engage the client in an examination of the logic of his/her dysfunctional thinking and to develop objective and abstract thinking that the client could relate to his/her personal experience/problem. Another useful strategy is to help the client to realize the consequences of holding on to his/her dysfunctional thinking and the potential benefits of changing. The purpose of the present paper is to discuss the conceptual and practical issues that underpin an evidence-based clinical framework for working with dysfunctional thoughts. This framework will be of interest to practitioners and counsellor working in diversity of settings such as schools, university and college counselling centres, mental health clinics and hospitals.