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Cognitive behavioral therapy for psychosis (CBTp) has enjoyed a steep rise in popularity over the past 15 years; however, recent systematic reviews and meta-analyses have concluded that CBTp has only modest effects on psychotic syndrome outcomes and that empirical evidence of its superiority over other psychosocial treatments is poor. And although it has been argued by some prominent authors that CBTp is not designed to alleviate the “psychotic syndrome,” there is little empirical evidence linking CBTp change mechanisms with syndrome versus single-symptom outcome measures. This study investigated the relationship between CBTp change processes, beliefs about voices, and thought control strategies, with a range of outcome measures including global positive psychotic symptoms in a sample of 40 voice hearers with established diagnosis of psychotic disorder. Consistent with the assertions of Birchwood and Trower (2006), global positive symptoms were found to be generally poorly related to CBTp change processes. Conversely, these CBTp change processes were found to be generally strongly related to measures of emotional distress and some measures of single psychotic symptoms. The implications for past and future CBTp treatment outcome studies are discussed.

Despite a steep rise in the evidence base for third-wave cognitive and behavioural therapy approaches over the past decade, a scarcity of change measures relevant to these therapies as applied to psychosis is arguably slowing empirical progress in the area. The Voices Acceptance and Action Scale (VAAS), a measure of acceptance of voice experiences, is a notable exception. However, there are no published data on its psychometric properties outside of that provided by the scale developers. The current study explored the psychometric properties of two brief versions of the VAAS in a sample of psychotic voice hearers in a routine outpatient mental health service. Evidence from the current study suggests that both brief versions are robust measures of acceptance of voice experiences. Some limited support for the shortened VAAS-9 as being a marginally improved scale over the original brief VAAS-12 was also found. The current study found acceptance of voices to be highly related to depression, anxiety, stress and general negative affect and to predict unique variance in depression and general negative affect beyond that attributable to negative beliefs about voices and thought suppression. It was also found that acceptance was positively related to the use of reappraisal, indicating that the distinctiveness of acceptance from appraisal processes may be less pronounced in this context than what was has been reported previously. Implications for future research, as well as the practice of second-wave and third-wave cognitive and behavioural approaches to psychosis, are discussed. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Two brief versions of the VAAS instrument were found to be robust measures of acceptance of psychotic voice experiences. The construct of acceptance of voices is highly related to indices of well-being and negative appraisal processes in psychosis and appears to offer an alternative route to therapeutically addressing the toxic effects of negative beliefs about voices. The recent focus on acceptance-based techniques within cognitive and behavioural approaches to psychosis was supported.

Objective: Deliberate self-harm (DSH) is common in Borderline Personality Disorder, may be due to a variety of reasons, and is associated with different degrees of suicidal intent. Understanding the reasons for episodes of DSH in this population may be helpful in developing interventions to reduce the rate of DSH or to assist in the clinical judgement of suicidal intention after DSH has occurred. Methods: The Parasuicide History Interview, version 2 (PHI-2) was used to determine the reasons for DSH events in 70 Australian women diagnosed with Borderline Personality Disorder. Factor analysis of the responses identified four empirically derived component factors. Multivariate models were developed to identify the independent predictors of suicidal deliberate self-harm (S-DSH) versus non-suicidal deliberate self-harm (NS-DSH) events. Results: Participants and raters showed strong agreement in classifying S-DSH and NS-DSH events. Methods used that involved self-poisoning, jumping or stabbing showed increased risk for S-DSH, adjusted odds ratio 12.07 (95% CI 2.17, 67.29), compared to the referent group, external damage to skin with no rescue contact being sought. Although no grouping of reasons were independently significant, the lower the effectiveness of the DSH event to resolve the reasons for the event, the higher the risk of it having been a S-DSH event. Conclusion: In clinical situations, any Borderline Personality Disorder patient seeking help or medical attention, using any method other than superficial external injury to skin, or reporting a failure to effectively resolve the reasons for the DSH event, should be considered as likely to have had a S-DSH event (greater suicidal intention). However, specific reasons for the DSH event, or individual subject characteristics, did not meaningfully distinguish S-DSH from NS-DSH events.

Problem-based learning (PBL) is a pedagogical approach to professional training that emphasises the development of clinical reasoning skills and self-directed learning. In contrast to more traditional lecture-based approaches that focus upon the linear acquisition of course content, PBL is undertaken in the context of actual case presentations. Although PBL has been adopted widely in the professional training of medical practitioners and nurses, it is only just beginning to be used in the professional education of psychologists. This paper examines the nature and benefits of PBL for education in clinical and forensic psychology by outlining its implementation and development at Charles Sturt University, located in a rural area of Australia. Although a full and independent evaluation of PBL for education in clinical or forensic psychology is yet to be undertaken, this paper argues that PBL can make a significant contribution to professional training in psychology.

Despite a rise in the popularity of cognitive behavior therapy for psychosis (CBTp) over the past 15 years, recent systematic reviews and meta-analyses have concluded that CBTp has only modest effects on psychotic syndrome outcomes and that empirical evidence of its superiority over other psychosocial treatments is poor (Jones, Hacker, Meaden, Cormac, & Irving, 2012; Wykes, Steel, Everitt, & Tarrier, 2008). However, for some time now, some authors prominent in the development of CBTp have argued the primary goals of CBTp not to be global syndrome reduction but the amelioration of emotional distress and behavioral disturbance in relation to individual psychotic symptoms (Birchwood & Trower, 2006). A review of the theoretical and empirical literature related to CBTp reveals broad support for this position. Implications and recommendations for research into the efficacy of CBTp are discussed.

This article presents the current state of knowledge in deliberate-self harm (DSH). DSH presents as a comorbidity with a number of personality disorders and psychopathologies, but is also relatively common in the psychologically healthy population. Over the past 10 years, attention has shifted from the investigation of DSH as a cardinal or comorbid symptom of psychopathology to an attempt to understand the behaviour itself, without reference to other psychopathological processes. It is argued that this development in understanding the aetiology of DSH has not been matched by developments in treatment or management of DSH, with the majority of treatment programs targeting larger syndromes of which DSH is a symptom. Treatment regimes aimed at reducing DSH appear to be either untested or demonstrably unsuccessful.

Introduction to clinical practice through a university-based psychology clinic has been argued to be an essential component of the training of clinical psychologists. It has also been argued, however, that a university-based clinic does not provide trainee therapists with realistic exposure to the world of clinical practice. The records maintained by the University of New South Wales School of Psychology Clinic over a 7-year period were examined in order to evaluate the actual and potential role of such university-based clinics, both in training and in provision of psychological services to the wider community. The range of people who received services through the psychology clinic, the nature and range of their difficulties, and the volume and consistency of services provided all indicate that this clinic has provided valuable, and relevant, training and service delivery functions.

Eighty-eight patients suffering panic disorder with agoraphobia and reporting at least one unexpected panic attack in the past month were sent questionnaires designed to examine some of the factors which may be associated with their avoidance. The subjects were divided into three groups based on their degree of avoidance: minimal avoidance, moderate avoidance, and marked avoidance. There were a number of differences between the groups which appeared to be reducible, on face validity, to two basic features. First, patients with greater avoidance were more likely to perceive influences and triggers for their panic attacks, whereas those with less avoidance appeared more likely to believe that their attacks were independent of any external factors. Second, the degree of avoidance seemed to be related to scales measuring social anxiety, introversion, and unassertiveness. The data are discussed with relation to a theory of avoidance behavior, and further, more specific research is encouraged.

Single inhalations of a 50% carbon dioxide/50% oxygen gas mixture were administered to 16 subjects with spontaneous panic attacks and to 16 social phobics who did not experience such attacks. Half of each diagnostic category was randomly allocated to either a no explanation condition in which minimal instructions on expected outcome were provided, or an explanation condition in which all possible sensations were described and attributed to the effects of the gas. Subjects with panic attacks who were given no explanation reported a greater proportion of catastrophic cognitions, greater panic, and a greater similarity of the overall experience to a naturally-occurring panic attack than those with panic attacks who received a full explanation. In contrast, both groups of social phobics reported similar effects to each other, regardless of the explanation given. The results provide support for cognitive mediation in the "panic" component of spontaneous panic attacks.