Previous research has found an association between adult attachment style and symptoms of depression among university students and indicated that this relationship may be mediated by dysfunctional attitudes. The present study represents an initial step toward extending these findings to a clinical sample with more severe forms of depression. A sample of psychiatric outpatients diagnosed with major depressive disorder (n = 54) completed measures of adult attachment style, dysfunctional attitudes, and depression. An association was found between insecure attachment style and depression severity. This association was partially mediated by dysfunctional attitudes. These findings are consistent with cognitive-interpersonal models of depression that propose that adverse early experiences may contribute to vulnerability for depression through the establishment of dysfunctional attitudes.

Little is known about the weight, shape and eating concerns of mothers with young, overweight daughters. Even less is known about how these relate to their daughters' concerns. In a small pilot study (18 mother-daughter pairs in each group), general concerns and specific beliefs related to eating disorders were assessed, both in the mothers of overweight girls and in the mothers of average weight girls. These were then compared with their daughters' concerns. The findings indicated that mothers with overweight daughters (aged 11 and 12 years) scored more highly than the mothers of average weight girls on both general concerns and specific beliefs (i.e., underlying assumptions about weight, shape and eating and negative self-beliefs) related to eating disorders. While assumptions in mothers were highly correlated with daughters' concerns in the average weight group, no such relationship was found in the overweight group. The findings are briefly discussed and suggestions are made for further research.

Primary school aged children with severe learning disabilities and behavioural problems were identified from those attending special needs schools in three adjacent Inner London boroughs. In two of the boroughs their parents/carers were randomly allocated to receive 5-7 group- or individually-based intervention sessions aimed at preventing or reducing their child's behaviour problems; teaching and support staff at their schools received a 2-day workshop with the same aims. Children in the third borough served as a “no treatment” control group. Follow-up assessments were carried out shortly after the interventions were completed and 6 months later. Individually-based intervention was superior to group-based intervention in acceptability, attendance, levels of participant satisfaction and the likelihood of reported behavioural improvement. Within the individual intervention group, behaviours that had been targeted for intervention were more likely to show improvements than those that were untargeted. However, in spite of these improvements, there were no significant differences between groups in the absolute frequency or severity of the child's behaviour problems at either post-intervention assessment, and reductions in levels of parental distress noted on completion of the interventions were no longer apparent 6 months later.

Self-focused attention, also thought of a self-absorption, has been linked to a variety of affective states and clinical syndromes, including depression, panic disorder, social anxiety, schizophrenia, and alcoholism. Ingram (1990b) has suggested that self-focus may be a “nonspecific process” that is common across psychopathologies. Studies with nonclinical samples have supported this contention, and the current study assessed whether self-focus was common across various clinically diagnosed groups. A second issue, given this commonality, was to examine the factors across diagnostic conditions to which self-focus was related. One hundred and thirty-eight outpatients were included, and were divided into three groups based on primary diagnosis: “depression”, “panic”, and “other anxiety”. They were assessed with the ADIS-R/IV and completed measures assessing self-focus, affective states, global psychopathology, and problem-solving. Self-focus was common across groups, with minor valence variations. Severity of primary diagnosis predicted total self-focus, with level of depression and trait anxiety predicting negative self-focus. Correlational analyses suggested that self-focused attention is related to general measures of psychopathology and severity, and negatively related to problem-solving. The pattern with negative self-focus was even more pronounced, with significant relationships to all measures of psychopathology, clinician-rated severity, and a negative relationship with problem-solving. Results are discussed in terms of differences between “normal” and problematic self-focus, the causal direction in the relationship between self-focus and negative affect, and the link between self-focus and problem-solving.

It is hypothesized that there might be two subtypes of dysphoria. Comparison of the characteristic deficits of attributional styles and social skills of adolescent dysphorics differentiated them into two subtypes. This suggested that matched treatments of the two subtypes of dysphoria might be more effective than non-matched treatments. As is predicted by the hopelessness theory of depression (Alloy, Abramson, Metalsky, & Hartlage, 1988), dysphorics characterized by the depressogenic attributional style and adequate social skills reported significantly greater numbers of negative life-events than dysphorics characterized by social-skill deficits and healthy attributional style. Treatments matched to dysphoria subtypes were more effective than non-matched treatments. The authors suggest that similar tests of dysphorics over several years might indicate that some dysphoric states intensify and that matched treatments would abort potentially severe depressions.

This paper presents a cognitive behavioural perspective on factitious disorder. The DSM-IV definition will be given and aetiological and epidemiological information will be presented, whilst noting the difficulty in collecting data from this group. The difficulty in engaging the patient will be addressed. In assessing the patient, the role of early experiences, the beliefs about their feigning of symptoms, the gains from this behaviour and the reaction of others will be considered. The similarities with somatization and malingering will be discussed. A model of this disorder based on the Beckian approach will be given as will an explanation of why this disorder may become chronic. A treatment strategy will be suggested looking at helping the patient understand their disorder, discussing with them the pros and cons of alerting others to their feigning behaviour, helping them get their needs met in a more appropriate way, looking at the risks involved in the behaviour, and addressing issues of abuse.

Recent publications have suggested that practising cognitive therapy (CT) techniques on oneself may be valuable in the development of cognitive therapists' clinical skills. The present study asks: Is this useful? If so, in what ways? We report a qualitative study of the experience of trainees undertaking a CT training course, which included an explicit self-practice (SP) and self-reflection (SR) component. Key features of the learning process were: (i) experiencing cognitive techniques from the client's perspective, and (ii) reflecting on this experience that led to (iii) a “deeper sense of knowing” of CT practices. The primary learning outcome was an enhancement of therapeutic understandings, which trainees reported to be both professionally and personally useful. Professionally, they reported deeper understanding of the therapist's role, the cognitive model and change processes. Personally, SP/SR led to greater understanding of themselves, and to the perception of CT as a useful tool for personal change. The data also suggested two other positive learning outcomes: an enhancement of therapist skills and therapist self-concept. We conclude that SP/SR may be a valuable component in CT training. Guidelines and recommendations for inclusion of SP/SR in training courses are discussed.

Recent research suggests that cognitive-behaviour therapy (CBT) can significantly improve outcomes for patients with severe mental health problems. However, there are no tools specifically designed to assess competence in delivering CBT to psychotic patients. This study investigates the psychometric properties of the Cognitive Therapy Scale for Psychosis (the CTS-Psy) for assessing the quality of CBT with psychotic patients. Inter-rater reliability of trained raters using the CTS-Psy was investigated using taped therapy of trainees engaged in a CBT oriented psychosis training course. Validity was investigated in relation to examining the degree to which the scale could be used to assess a range of therapist ability and patient severity and by assessing the degree to which the CTS-Psy could pick up changes in skill acquisition during the training course over a 9-month period. The CTS-Psy demonstrated excellent inter-rater reliability and good validity in relation to it being able to rate all standards of therapy and all types of patient sessions in the sample studied. In addition, the scale was sensitive to changes in clinical skills during a training course and could discriminate between those who had received training and those who had not.

Selective attention for bodily sensations is often found in patients with panic disorder. Whether this may be the result of fear was investigated in a group of normal subjects. Subjects were made to fear an acceleration in their heartbeats or an increase in their muscle tension by threatening them with an electric shock should this occur. When subjects were under threat of these shocks, attention for ECG and EMG feedback was measured. Although the task seemed sensitive to the manipulation, no evidence was found for selective attention for fear-relevant information. Several shortcomings of the task are discussed.

Paralleling developments in other areas of clinical psychology, psychological theories of chronic pain have evolved from the purely behavioural models of several decades ago, to those that have increasingly recognized the importance of cognitive constructs (without necessarily neglecting the influence of behavioural factors that remains significant). As is well established in the domains of anxiety and depression, pain related cognitions and coping strategies are now considered to be just as, if not more, important as behavioural constructs such as reinforcement contingencies. At the same time, however, some of the exciting developments in other clinical areas have only just begun to receive due attention from those interested in pain. In particular, the “safety seeking behaviours” construct, which has received a considerable amount of attention in recent years from anxiety researchers, appears to have been virtually ignored by those researching pain. Although related constructs such as “fear avoidance” have increasingly been recognized and investigated, specific reference to safety behaviours (in relation to pain) does not seem to have occurred. This paper presents a brief overview of how the concept of safety seeking behaviours could be applied to chronic pain patients. Although not advancing a radically new approach, it is argued that there are theoretical and clinical advantages to integrating safety seeking behaviours in to psychological models of pain.

Post-traumatic stress disorder (PTSD) is one of a range of trauma responses and has claimed the most therapeutic attention, but other post-traumatic states are probably, collectively, as common and produce a comparable level of functional impairment. It is suggested that in accordance with the cognitive theory of emotional disorders (Alford & Beck, 1997) the post-traumatic states are distinguished by differing cognitive content. Further, it is suggested that PTSD clients have particular information processing biases and those with a chronic form of the condition have a cognitive profile similar to those with a personality disorder. The differing cognitive architecture amongst the post-traumatic states suggests different treatment focii (Scott & Stradling, 2001).

Thank you to all those who participated in the review process for Behavioural and Cognitive Psychotherapy during 2000.