Despite promising findings from problem-solving interventions in the treatment of parasuicide, little is known about problem-solving difficulties that distinguish “Non-Repeaters” from “Repeaters”. The present study examined whether problem-solving ability could be used to identify repeaters of parasuicide. Findings are presented from the follow-up part (N = 35) of a larger investigation (N = 146) of non-consecutive hospital-treated cases of parasuicide, interviewed by the National Suicide Research Foundation in Ireland as part of the WHO/EURO Multicentre Study on Suicidal Behaviour. The median interval from initial to follow-up interview was 15 months. The European Parasuicide Study Interview Schedule (EPSIS II) was used in the follow-up interview. Within this schedule, responses to a questionnaire measuring habitual problem-solving style were analysed. Repeaters scored significantly lower than non-repeaters on the following problem-solving dimensions: Active handling, Comforting cognitions and Seek social support. Repeaters scored significantly higher on the Passive reactions dimension. A logistic regression model including these four problem-solving dimensions correctly identified 79% of the repeaters and 82% of the non-repeaters. Despite the limitations of this sample size, these significant differences in problem solving have implications for the treatment of parasuicide. Further work, using larger samples, is required.

A number of studies have demonstrated that patients suffering from PTSD show differences from appropriate controls in psychophysiological responding. This study aimed to investigate whether there were differences in habitu ation and psychophysiological reactivity between PTSD patients and normals, and between patient subgroups depending on their symptoms and whether psychophysiological variables were associated with clinical outcome from a treatment trial. Participants were tested by measuring electrodermal activity to two sets of 15 auditory stimuli of different intensity, and to six vignettes, four neutral, one of general stress and one trauma related. Psychophysiological variables were entered into a multiple regression with clinical outcome as the dependent variable. There were no differences between patients and controls or within patients on the habituation paradigms. Patients differed from controls only on their response to the trauma related vignette. There were no differences on any within patient compar isons. There was no association with these measures and later clinical outcome. Psychophysiological differences between PTSD patients and normal controls are very specifically related to trauma related stimuli. Patients with startle or high arousal symptoms do not show differences from those without. These measures were not related to treatment response.

This issue sees the introduction of another journal section. I have been aware for some time of both the importance and strength of systematic reviews, meta-analyses and other published aspects of what has come to be termed “evidence based medicine” (EBM) and “evidence based mental health” (EBMH). At the same time, there is a co-existing uneasiness that something was missing, and that EBM promised more than it was able to deliver. There is a sense of scientific sterility that goes with this approach. It does not seem to be a complete formula for making sense of the existing literature, and it falls far short of what is needed for the scientific development of our ability to understand and treat psychological distress. This unease is increased by the way in which it appears that EBMH approaches provide definitive answers, an algorithm against which current science and clinical practice is to be weighed.

The aim of this study was to compare the trauma sensitive beliefs of individuals who had never experienced an assault with the preassault and postassault beliefs of assault victims. Seventy-two individuals who had never experienced an assault completed a questionnaire designed to assess trauma sensitive beliefs (including beliefs about self-worth, safety and the trustworthiness of others). The beliefs of this group were then compared with the preassault and postassault beliefs of assault victims with persistent PTSD and assault victims who had never experienced PTSD, recruited for previous studies (Dunmore, Clark, & Ehlers, 1999, 2001). Results showed that victims who did not develop PTSD following assault reported significantly more positive preassault beliefs in comparison with those who had never been assaulted. The postassault beliefs of the persistent PTSD group were significantly more negative than the beliefs of the never assaulted group and the no PTSD assault group. Findings support evidence that suggests a relationship between negative beliefs after assault and the development of PTSD. In addition, positive preassault beliefs might play a “buffering” role, minimizing the impact of assault for those assault victims who do not subsequently develop PTSD.

The present study investigated the role of cognitive processes in the maintenance of clinically significant sleep disturbance across two cultures. A questionnaire was administered to 60 Japanese and 60 English university students to assess the presence of sleep disturbance, predominance of pre-sleep cognitive activity, use of thought management strategies to control pre-sleep cognitive activity, and the content of pre-sleep cognitive activity. The results indicated that across both cultures poor sleepers attributed their sleep disturbance to the presence of uncontrollable pre-sleep cognitive activity. Minor differences between the Japanese and English samples included the strategies employed to control pre-sleep cognitive activity. The English participants were more likely to engage in reappraisal whereas the Japanese sample were more likely to engage in punishment and worry. These results are suggestive of the cross-cultural applicability of cognitive models of insomnia.

Attention deficits and inflated perceptions of responsibility have been identified as characteristics of people with obsessive-compulsive disorder (OCD). The present study examined the relative importance of responsibility and attention in predicting non-clinical levels of obsessionality. Three hundred Australian university students were screened using the Maudsley Obsessional-Compulsive Inventory (MOCI), and students who scored in the top and bottom 10% of the distribution were selected for participation. The selected participants completed the Responsibility Attitude Scale (RAS) and the Test of Everyday Attention (TEA), along with measures of trait-anxiety and depression. High MOCI scorers exhibited a greater perception of responsibility, and poorer overall attention than low MOCI scorers. These differences remained significant after controlling for trait-anxiety and depression. Logistic regression analyses revealed that responsibility was a stronger predictor of non-clinical obsessionality than was attention. Moreover, attention did not make a significant contribution to the prediction of obsessionality once responsibility had been controlled. Correlations between responsibility and TEA visual selective attention subtests remained significant after controlling for obsessionality. These findings suggest that measures of attention (particularly measures of visual selective attention) may be confounded by responsibility attitudes, thus highlighting the importance of controlling for meta-cognitive variables such as responsibility when investigating attention in OCD.

The current emphasis on Evidence Based Medicine (EBM) is both welcome as a bid to improve the empirical foundations of clinical practice and a cause for concern because it has the potential to distort the scientific approach that has underpinned the development of cognitive-behavioural approaches. It is suggested here that EBM needs to be seen in context; that is, as an approach that almost exclusively focuses on just one of the dimensions that have been and are crucial to the further development of Cognitive-Behavioural Treatments (CBT). EBM is particularly well suited to the development of Biological approaches to treatment, where treatments (and treatment development) are largely atheoretical. However, different considerations apply to CBT, where validated theory and linked research studies are key factors. It is suggested that relationship to evidence in CBT is best conceptualized in terms of Empirically Grounded Clinical Interventions. The parameters of such an approach are considered in relation to the Scientist Practitioner model that is prevalent in the field.

It has been noted that obsessional patients appear to be equally sensitive to ideas regarding the possibility that they may cause harm by both their actions and by their failure to act (i.e., omission). This observation is discrepant with findings in non-clinical populations. The cognitive theory of obsessive-compulsive disorder suggests that it is the very occurrence of intrusive thoughts about potential harm that mediates this effect. In this study, 22 obsessional patients and 30 non-clinical participants were provided with details of ambiguous situations and either a negative or neutral intrusive thought pertaining to this situation. Behavioural and emotional responses to these situations were rated using self-reported measures. It was found that situations including an intrusive thought about harm were associated with higher intensity behavioural and emotional responses compared with the same situation when the intrusion was neutral. Obsessional participants scored higher overall; only on the rating of perceived responsibility was there an interaction between group and item type. These results are consistent with the idea that the occurrence of an intrusion about harm modifies both obsessional and non-clinical participants' reactions in ways that suggest obsessionality, and support cognitive theories that emphasize that obsessional experiences arise from normal processes.

Inconsistent results have emerged in thought suppression studies using thought frequency counts as the primary dependent measure. In the present study, we used cognitive and emotional measures to assess the effects of suppressing negative self-referent and neutral thoughts. Although no between-group differences in cognitive outcomes emerged, participants in the negative self-referent thought condition experienced more anxiety, frustration, and hostility than did participants in the neutral thought condition. Affective measures appear necessary to assess the effects of suppressing personally relevant thoughts.

Cognitive-behavioral models (Clark & Wells, 1995; Rapee & Heimberg, 1997) and recent research suggest that individuals with social phobia (SP) experience both images (Hackmann, Surawy, & Clark, 1998) and memories (Coles, Turk, Heimberg, & Fresco, 2001; Wells, Clark, & Ahmad, 1998) of anxiety-producing social situations from an observer perspective. The current study examines memory perspective for two role-played situations (speech and social interaction) at multiple time points (immediate and 3 weeks post) in 22 individuals with generalized SP and 30 non-anxious controls (NACs). At both time points, SPs recalled the role-plays from a more observer/less field perspective than did NACs. Further, over time, the memory perspective of SPs became even more observer/less field while the memory perspective of NAC remained relatively stable.

Recent research indicates the apparent paradox that social anxiety may be associated with both self-focused attention and selective attention to external social threat cues. A naturalistic paradigm was designed to explore both processes. High and low socially anxious individuals were asked to make a speech to a monitor displaying six people whom they believed to be watching them live. Two audience members exhibited only positive behaviours, two only neutral ones and two only negative behaviours. In contrast to the low social anxiety group who selectively discriminated positive audience members, the high social anxiety group selectively discriminated the negative individuals, yet they were no more accurate at discriminating the negative behaviours the audience members had performed and they reported more self-focused attention than the low social anxiety group. The effects remained while covarying for differences in dysphoria. The results indicate that socially anxious individuals base their judgements of being disapproved by others on limited processing of their social environment.

Studies of in-service training demonstrate repeatedly the difficulty of transferring training to the routine work of the staff. One of the likely explanations for this difficulty is the recurring absence of an educational and organizational needs assessment to guide the training. Such assessments can play a critical role in defining management support, goal setting, the selection of the trainee group and in analysing the readiness of staff in an organization for a training intervention. The present study summarizes and extends prior research in the field of mental health by conducting a comprehensive educational and organizational needs analysis. Six assessment methods were administered to N = 72 staff and 20 clients in a psychiatric hospital, including questionnaires, interviews, direct observations and an audit. The study design was based on a series of naturalistic, cross sectional comparisons between four wards. Significant differences were obtained between the four participating wards, which served to define training needs and to validate the needs assessment procedure. Implications are drawn for needs assessment within a more systematic approach to staff training.

Activation of a depressogenic schema by a negative life event is said to be more likely when the life event corresponds to the same domain of vulnerability (congruency hypothesis). Specifically, this refers to a negative interpersonal event for the sociotropy/dependency schema, and an obstacle or a failure in achieving a goal for the autonomy/accomplishment or self-criticism schema. This study examines the congruency hypothesis for the prediction of relapse. Older patients were followed for 6 months after remission from major depression. Life events were rated as interpersonal or autonomous in nature. Their subjective impact on social relations and on autonomous functioning was also assessed. Congruency between dependency schema and interpersonal events, but only when the subjective impact of event was taken into consideration, predicted relapse. Non-congruency between an autonomous schema and an event rated as impacting the social domain also predicted relapse. However, in both analyses of dependency and autonomy schemas, impact of event on social relations on its own predicted relapse. These findings support the cognitive vulnerability theory of depressive relapse, underlining the importance of considering how the person views the influence of life events and the determining impact of stressful life events on social relations.

This study reports the factorial structure and psychometric properties of a Spanish version of the Padua Inventory (PI) in a sample of 863 undergraduate students, 55 patients with Obsessive-Compulsive Disorder (OCD), and 20 patients with other anxiety disorders (OAD). A Principal Components Analysis suggested a 4-factor structure, which was comparable but not identical to that found in other versions of the PI involving non-clinical samples. The PI sub-scales showed good internal consistency, test-retest reliability, as well as convergent and discriminant validity. The “Washing” sub-scale of the PI failed to separate OCD and OAD patients, although this may have been due to small sample sizes. It is suggested that a revised version of the PI should include symptoms that are not currently represented in the scale, such as hoarding obsessions and compulsions.

There is a substantial literature reporting the co-occurrence of maternal depression and child behaviour problems. Behavioural interventions have proven efficacy in the treatment of conduct problems, and a number of studies have reported gains in parental mental health following parent training. The mechanisms by which this is achieved are not clear, but it is likely that interventions that include parent training in observation skills and exposure to success will impact on both the child's conduct problems and maternal depression. This paper reports on the outcomes of two treatments for children with severely disruptive behaviour, the standard treatment offered by a Child and Adolescent Mental Health Service, and an intensive parent training intervention. It was predicted that the more specific skills training in the intensive treatment would make improvements in maternal health and child behaviour more likely. Significant overall improvements were found in measures of child behaviour, parental practices and maternal mental health. A correlation emerged between the improved child behaviour and the improved parenting strategies. Significant improvements for the intensive treatment group were seen on every measure. Significant improvement in the measure of maternal mental health contrasted with little change for the standard treatment group.

This study compared complaints management training and cognitive therapy (reattribution) in treating panic disorder. Both treatment groups received three sessions with initial psychoeducation. Thirty patients with panic disorder took part in the study. Assessments were carried out before and after treatment and again at a 4-week follow-up. Both groups showed similarly significant improvements and maintenance of the clinical change over the follow-up period. It is concluded that the initial psychoeducation, which conveyed to patients the cognitive-behavioural model of panic disorder, contributed to the treatment outcome.

Cognitive therapy has traditionally assumed that the therapy relationship provides a necessary context for intervention but is insufficient alone to produce therapeutic change. This assumption is reviewed in the light of up-to-date evidence from research studies of cognitive therapy and recommendations are made for further research. Mechanisms by which the therapy relationship may influence outcome and factors influencing the quality of the relationship are briefly discussed and the need for further research highlighted. Implications for the practice of cognitive therapy are suggested.

The growing interest in the use of cognitive behaviour therapy with children and young people has been encouraged by emerging evidence suggesting that CBT is effective with a wide range of child disorders. Typically, models and techniques developed for work with adults have been extended downwards and applied to children. This review questions the appropriateness of this approach and selectively identifies a number of key issues that need to be addressed. The absence of developmentally appropriate theoretical models to understand the onset and maintenance of maladaptive cognitive processes in children is highlighted. This lack of a coherent theoretical framework has led to a proliferation of diverse interventions falling under the general umbrella of cognitive behaviour therapy with the predominant emphasis being behavioural, rather than cognitive. Developmental factors, the nature, extent and type of cognitive processes in children and the important role of the parent in the onset and treatment of childhood problems have received comparatively little attention. There is a need to understand more about the cognitive processes of children and young people and to develop robust and testable developmentally appropriate theoretical models. In turn this will begin to address the question of which specific cognitive behaviour therapy programmes are effective for which childhood problems.

Comorbidity data between Generalized Anxiety Disorder (GAD) and Social Phobia, studies of frequently reported worry themes, and various correlational studies have led to the idea that worries may have a social basis. This study investigates the social basis of worry in three samples with different ages. The samples consisted of 224 high-school students, 607 undergraduate students, and 125 older adults. All participants completed the Worry Domains Questionnaire (WDQ) and the Penn State Worry Questionnaire (PSWQ). We hypothesized that for each sample, the first factor extracted following factor analysis on WDQ items would reflect the most social content, and that social-related factors would be the best predictors of the global tendency to worry as measured by the PSWQ. Results supported the hypotheses with the exception of older adults, for whom the first extracted factor was not as obviously social as for the other two samples. Possible explanations are considered and theoretical and clinical implications are discussed.

This paper describes a distinct clinical approach to the treatment of Posttraumatic Stress Disorder (PTSD). It is theoretically guided by recent cognitive models of PTSD and explicitly combines cognitive therapy techniques within exposure/reliving procedures. A clinically pertinent distinction is made between the cognitions and emotions experienced at the time of the trauma and, subsequently, in flashback experiences, and secondary negative appraisals. The term peritraumatic emotional “hotspot” is used to describe moments of peak distress during trauma. It is argued that a focus on cognitively restructuring these peritraumatic emotional hotspots within reliving can significantly improve the effectiveness of the treatment of PTSD and help explain some treatment failures with traditional prolonged exposure. An approach to the identification and treatment of these hotspots is detailed for a range of cognitions and emotions not limited to fear.