A cognitive approach to the understanding of psychotic symptoms that focuses on the interpretation of intrusions into awareness is outlined. It is argued that many positive psychotic symptoms (such as hallucinations and delusions) can be conceptualized as intrusions into awareness or culturally unacceptable interpretations of such intrusions, and that it is the interpretation of these intrusions that causes the associated distress and disability. It is also argued that the nature of these interpretations is affected by faulty self and social knowledge and that both the intrusions and their interpretations are maintained by mood, physiology, and cognitive and behavioural responses (including selective attention, safety behaviours and counterproductive control strategies). The literature is reviewed and found to be compatible with such a model and the clinical implications are discussed.

The literature on the use of cognitively based anger control packages of treatment for people with learning disabilities is reviewed. It is found that the experimental evidence for the effectiveness of such treatment is weak. There is, however, good evidence that two of the components of the package, relaxation and self-monitoring, can be effective in their own right, with relaxation being found to reduce anger and self-monitoring to reduce other challenging behaviours. The use of cognitive procedures with people who have learning disabilities is discussed.

The attributions parents make about the problem behaviour of their children have been shown to be important determinants of their emotional and behavioural reactions to such behaviour. However, this relationship has not been studied in carers of children in residential settings. In this paper we apply Weiner's attributional model of helping to the self-predicted behaviour of 47 carers in residential children's homes in the U.K. Participants identified causes for four children's behaviours, made attributions about these behaviours on dimensions of internality, controllability, globality and stability, reported their emotional reactions to the behaviours on the dimensions of anger and sympathy and reported their likelihood of making extra effort to help in working with these behaviours. Results showed that attributions of controllability and globality, and the emotional response of sympathy were important in predicting reported likelihood of helping. The implications of these results for carer training are discussed.

A considerable literature has developed over the past two decades that has investigated the utility of cognitive behavioural treatments for a variety of medical disorders, including rheumatoid arthritis. Research has consistently found that psychological variables affect the course of the illness and that cognitive behavioural approaches can improve psychological and physical function. However, the literature has focused almost exclusively on chronic illness. There is little literature that has investigated the role of cognitive behavioural therapy in facilitating the adjustment early in the disease course to diagnosis and subsequent illness. The diagnosis of any potentially chronic illness has enormous ramifications for a person's life and it is well documented that many people become depressed even early in the disease course. Theoretical accounts have been put forward that allow a model for understanding the process of adaptation and offer a foundation for the use of cognitive and behavioural strategies with a recently diagnosed group of patients. The present paper reports the use of a cognitive and behavioural intervention to facilitate coping and adjustment to illness.

In the present climate of limited resources and long waiting lists, it is not surprising that there is more emphasis on making sure that psychological treatments are not only clinically sound but also cost-effective. One solution to this is to provide time-limited, focused interventions such as cognitive therapy. Another obvious solution is to deliver treatment in groups rather than individually. However, what evidence is there that therapy can be delivered as effectively in groups as individually? This review will look at which different formats have been tried, what the advantages and disadvantages of those formats might be, which client groups have been targeted for cognitive- behavioural group therapy (CBGT), and whether a group format in general offers any advantages over individual CBT. Outcome studies and their implications for the use of CBGT are considered. Results suggest that, in most client groups, there is little difference in efficacy between group and individual CBT, although there is some evidence that results for some types of patient can be disappointing in CBGT. It may be that the best compromise in terms of cost- effectiveness between quality of therapy and quantity of patients treated is offered by large-scale psychoeducational didactic group therapy.

This open study measured the proportion of routine referrals from primary care to a psychiatric sector team with symptoms of anxiety and/or low mood who chose to take up the option of attending a self-help room to use the CBT self-help manual Mind over mood during a 6-week waiting list period. It assessed changes in psychological health, dysfunctional attitudes and degree of hopelessness during the period of use of the self-help manual, as well as patient satisfaction with it. Twenty-two of 42 consecutive referrals attended the room (mean 3.55 sessions – SD 1.71). The Beck Hopelessness Scale (BHS), the General Health Questionnaire (GHQ), and Dysfunctional Attitudes Scale (DAS), as well as measures of patient participation and satisfaction, were completed at the beginning and end of the 6-week period for those patients who attended the room. All three scale scores fell significantly over the study period, and the DAS and BHS scores at 6 weeks were negatively correlated with the number of sessions attended. The patients generally judged that the self-help intervention was acceptable and effective, and that their knowledge in a number of key areas had been improved. Conclusions regarding effectiveness are limited by the absence of control group data; nonetheless, this study does suggest that the provision of a self-help room containing Mind over mood is useful for patients with anxiety and low mood on a waiting list for a psychiatric outpatient assessment.

In the self-regulation of anger, it is unclear whether the effects are due to self-monitoring or actual self-intervention. This is especially important in the light of the reactivity often attributed to self-monitoring. The present study compared both procedures within a reversal design involving college students with moderate levels of anger. Intervention consisted of behavioral contracting and relaxation as well as cognitive strategies of reappraisal and imagery. Measures included anger frequency, duration, and intensity, all of which were obtained in naturalistic settings. Results revealed significant and dramatic reductions in anger frequency and duration during self-intervention but no such improvements with self-monitoring apart from a slight reduction in anger intensity. The return to baseline self-monitoring was associated with no relapse in anger but a maintenance of treatment gains. Secondary findings of interest were a correlation between anger intensity and anger duration and a predominance of anger directed at persons rather than situations. In general, the outcome of this study adds strength to the inference that cognitive-behavioral self-interventions are effective for anger and that this effectiveness goes beyond mere reactivity. The effects are most pronounced for anger frequency and duration and this offers clues for future focal points in the practice of anger management.

In the course of studies of behavioural parent training with the families of young children who were demonstrating serious conduct disorders, a substantial proportion of the parents reported, without the information being solicited in any way, that their children had become far more loving and demonstrative than formerly. They were surprised and delighted by this development. The concepts of “attachment” and “attachment behaviours” are explored and the usefulness of learning theory in understanding the extinction and recovery of attachment/attachment behaviours is discussed. This formulation may provide a bridge between cognitive learning theory on the one hand and attachment theory on the other.

Individuals with posttraumatic stress disorder (PTSD) frequently report periods of intense emotional distress (“hot spots”) when asked to describe their traumatic experience in detail. “Primary” emotions felt during the trauma (i.e., peri-traumatically) are believed to consist mainly of fear, helplessness and horror. We report a preliminary investigation into the emotions associated with these hot spots. Patients with PTSD described a wide variety of emotions such as anger, humiliation and guilt present at the time of the trauma. The peri-traumatic cognitions associated with these emotions are also detailed.

A combination of synchronous reinforcement and verbal prompts (automatically delivered through portable technology) was used to promote performance fluency in a person with profound intellectual disability and blindness. Performance fluency was measured on indoor walking and task engagement. Data indicated that the combination of reinforcement (favourite songs) and prompts was quite effective; it increased the distance covered per minute and the number of objects disassembled per minute. Implications of the findings are discussed.

The aim of this paper was to determine the features of pathological gamblers who dropped out of the treatment or relapsed within a one year follow-up period. The sample consisted of 69 patients selected according to DSM-IV criteria. Results indicated that the only difference between the patients who dropped out of treatment and the ones who completed was the level of state-anxiety. The former were more anxious than the latter. Predictive variables for the therapeutic failure were the dissatisfaction with the treatment, the high level of alcohol consumption, and the neuroticism as a personality variable. Implications of the study for clinical practice and future research in this field are commented upon.