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Current policy in UK health services emphasizes that, where possible, people with intellectual disabilities should access the same services as people without intellectual disabilities. One of the barriers to this is the confidence of clinicians and therapists. In this paper, we report on the development of a scale to describe the confidence of therapists in working with people with intellectual disabilities (the Therapy Confidence Scale-Intellectual Disabilities [TCS-ID]). One-hundred and eighty-one therapists who provided talking therapies but who did not work primarily with people with intellectual disabilities completed the scale; 43 people completed the scale twice for test-retest reliability purposes. One-hundred and seven people also completed a scale of general therapy self-efficacy. The TCS-ID has a single factor structure accounting for 62% of the variance, Cronbach's alpha for the scale is 0.93 and test-retest reliability is 0.83. There are significant differences in confidence based upon participants experience in working with people with intellectual disabilities and their therapeutic orientation, and there is a significant association between the TCS-ID and the General Therapy Self-efficacy Scale. Sixty clinicians working in mainstream mental health services received training on adapting their therapeutic approaches to meet the needs of people with intellectual disabilities. The TCS-ID was used pre-training and post-training and demonstrated a significant increase in confidence for all group. We suggest that the scale has good psychometric properties and can be used to develop an understanding of the impact of training for mainstream therapist in working with people with intellectual disabilities. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message There is increasing emphasis on people with intellectual disabilities receiving services from mainstream mental health services., There is no research describing the experiences and outcomes of people with intellectual disabilities receiving mainstream talking therapy services., The confidence that clinicians have in working with people with intellectual disabilities may be a barrier to them receiving mainstream services., The Therapy Confidence Scale-Intellectual Disabilities is a psychometrically sound scale for measuring the confidence of therapists in working with people with intellectual disabilities and is a useful outcome measure for training clinicians to work with people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Research consistently provides evidence for the relationship between the therapeutic alliance (TA) and outcome across various therapies and presenting problems. Depression is considered the leading cause of disability worldwide, and there is substantial evidence for the efficacy for Cognitive Behaviour Therapy (CBT) in its treatment. At present, there is lack of clarity specifically about the relationship between the TA and outcome in CBT for depression. The present review is the first meta‐analytic review to explore this relationship and also considering moderators. Within a random‐effects model, an overall mean effect size of r = 0.26 (95% CI [.19–.32]) was found, indicating that the TA was moderately related to outcome in CBT for depression. The mean TA–outcome correlation is consistent with existing meta‐analysis that looked across a broad range of presenting problems and psychological therapies. A secondary exploratory analysis of moderators suggested the TA–outcome relationship varied according to the TA rater, where the relationship was weaker for therapist raters compared with clients and observer raters. Additionally, the results indicated that the TA–outcome relationship marginally increased over the course of CBT treatment. The results of the meta‐analysis are discussed in reference to the wider body of research, methodological limitations, clinical implications, and future directions for research. [ABSTRACT FROM AUTHOR]

Background Psychological interventions for bipolar disorders typically produce mixed outcomes and modest effects. The need for a more effective intervention prompted the development of a new cognitive behavioural therapy, based on an integrative cognitive model ('Think Effectively About Mood Swings' [TEAMS] therapy). Unlike previous interventions, TEAMS addresses current symptoms and comorbidities, and helps clients achieve long-term goals. A pilot randomized controlled trial (the TEAMS trial) of the therapy has recently concluded. This study explored participants' experiences of TEAMS, recommendations for improvement and experiences of useful changes post-therapy. Methods Fourteen TEAMS therapy participants took part in semi-structured interviews. Their accounts were analysed using interpretative thematic analysis. Two researchers coded the dataset independently. Member checks were conducted of the preliminary themes. Results Two overarching themes; 'useful elements of therapy' and 'changes from therapy' encompassed 12 emerging subthemes. Participants appreciated having opportunities to talk and described the therapy as person-centred and delivered by caring, approachable and skilled therapists. Some recommended more sessions than the 16 provided. Helpful therapeutic techniques were reported to be, normalization about moods, methods to increase understanding of moods, relapse-prevention, reappraisal techniques and metaphors. However, some did not find therapeutic techniques helpful. Post-therapy, many reported changes in managing mood swings more effectively and in their thinking (although some participants reported changes in neither). Many described increased acceptance of themselves and of having bipolar disorder, increased productivity and reduced anxiety in social situations. Conclusions The present study evaluates participants' therapy experiences in detail, including aspects of therapy viewed as helpful, and meaningful post-therapy outcomes. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message This is the first paper to qualitatively explore people's experiences of individual psychotherapy for bipolar disorders. It highlights elements of psychotherapy described as particularly helpful or unhelpful and the clinical changes viewed as most impactful., Participants reported benefitting in a number of ways from TEAMS therapy. They valued learning to reappraise and problem-solve situations and manage moods., Participants identified TEAMS techniques as helpful, such as exploring advantages and disadvantages of moods, and building healthy self-states. [ABSTRACT FROM AUTHOR]

Objective The objective of this paper was to examine the relationships between perceived parental bonding, Early Maladaptive Schemas (Young et al., 2003), and outcome of schema therapy of Cluster C personality problems and whether the perceptions of parental bonding could be influenced by schema therapy. Method The sample consisted of 45 patients with panic disorder and/or agoraphobia and Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Cluster C personality traits who participated in an 11-week inpatient programme consisting of two phases; the first was a 5-week panic/agoraphobia-focused cognitive therapy, whereas the second phase was a personality-focused schema therapy. The patients were assessed at pre-treatment, mid-treatment and post-treatment and at 1-year follow-up. Results Opposite to our hypothesis, lower paternal care at pre-treatment was related to more reduction in Cluster C personality traits from pre-treatment to 1-year follow-up. Maternal protection was related to the schema domains of impaired autonomy and exaggerated standards. Overall schema severity and the schema emotional inhibition at pre-treatment were associated with less change in Cluster C traits. Perceived maternal care was reduced from pre-treatment to 1-year follow-up, and more reduction in maternal care was related to less reduction in Cluster C traits. Discussion Parental bonding failed to predict treatment outcome in the expected direction, but maternal protection was related to two of the schema domains. Overall schema severity and the particular schema emotional inhibition predicted outcome. Furthermore, perceived maternal care was reduced from before to after treatment. Future studies should examine these questions in larger samples of Cluster C patients receiving schema therapy of a longer duration. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Most schemas within the impaired autonomy domain and the schema self-sacrifice seem to be related to low perceived maternal protection., Overall schema severity and the schema emotional inhibition predict a poorer outcome of schema therapy of Cluster C personality problems, and therapy should give priority to emotional inhibition when this schema is endorsed., Therapists should be aware that schema therapy carries the risk to lead to a more negative view of mother's care during upbringing and this risk is accentuated with less benefit of therapy. [ABSTRACT FROM AUTHOR]

Emotion-focused therapy (EFT) is an integrative and experiential treatment approach that views emotions as fundamentally adaptive and privileges attention to, and exploration of, emotional experiences. EFT has been demonstrated to be efficacious with depression, interpersonal trauma and marital discord, but application to anxiety disorders is in its initial stages. The purpose of this paper is to present the main principles of using EFT with socially anxious patients and to make the case that EFT is particularly well suited for working with this patient group. The primary change processes in EFT for social anxiety include improving emotion awareness, reducing experiential avoidance and the activation and transformation of shame that underlies the symptomatic anxiety. Such processes lead to less self-criticism, to more self-compassion and self-soothing and to a more favourable perception of the self. A case example is used to illustrate how these principles were applied with a socially anxious patient. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Although cognitive-behavioral therapies (CBT) are effective for social anxiety disorder (SAD), a substantial number of patients do not respond to CBT or remain considerably symptomatic at the end of treatment. Therefore, more treatment options for SAD are necessary in order to improve patient care., Emotion-focused therapy (EFT), which is an efficacious treatment for depression, complex trauma, and couples' distress may also be efficacious for SAD., EFT offers an emotion-based case formulation of SAD, in which social anxiety is conceptualized as secondary to primary maladaptive shame. A primary goal in EFT for SAD is to access and evoke shame in order to transform it. [ABSTRACT FROM AUTHOR]

Individuals with intellectual disabilities (ID) are more vulnerable to mental health difficulties than the general population, yet there are limited evidence‐based treatments available for this group. There has been a growing interest in adapting cognitive behaviour therapy (CBT) for this population; however, a framework describing how to modify cognitive challenging for a group characterized by cognitive impairment is lacking. The aim of this paper is threefold: (a) to describe how to implement cognitive challenging for adults with ID; (b) to report results from a pilot evaluation of a manualized, modified CBT‐ID programme for anxiety; and (c) to compare participants with mild versus moderate ID on post‐treatment cognitive challenging competencies. Results showed that the broad CBT‐ID programme significantly reduced anxiety in adults with ID as measured by self, informant, and clinician ratings. In addition, adults with mild but not moderate ID demonstrated competence across a range of specific cognitive challenging skills following treatment. These findings contribute to the growing evidence base for the use of CBT with people with ID. In addition, the framework described offers practitioners specific therapeutic methods to effectively challenge maladaptive thoughts that maintain anxiety in this population. [ABSTRACT FROM AUTHOR]

Although studies have shown that client feedback can improve treatment outcome, little is known about which factors might possibly moderate the effects of such feedback. The present study investigated potential therapist variables that might influence whether frequent client feedback is effective, including the Big Five personality traits, internal/external feedback propensity and self‐efficacy. Data from two previous studies, a quasi‐experimental study and a randomized controlled trial, were combined. The sample consisted of 38 therapists and 843 clients (55.4% females, mean age = 42.05 years, SD = 11.75) from an outpatient mental health institution. The control condition consisted of cognitive‐behavioural therapies combined with low frequency monitoring of clients' symptoms. In the experimental condition, high‐intensity (i.e., frequent) client feedback as an add‐on to treatment as usual was provided. Outcomes were measured as adjusted post‐treatment symptom severity on the Symptom Checklist‐90 and drop out from treatment. The final model of the multilevel analyses showed that therapists with higher levels of self‐efficacy had poorer treatment outcomes, but when high‐intensity client feedback was provided, their effectiveness improved. Furthermore, higher self‐efficacy was associated with a higher estimation of therapists' own effectiveness, but therapists' self‐assessment of effectiveness was not correlated with their actual effectiveness. The results of this study might indicate that therapists with high levels of self‐efficacy benefit from client feedback because it can correct their biases. However, for therapists with low self‐efficacy, client feedback might be less beneficial, possibly because it can make them more insecure. These hypotheses need to be investigated in future research. [ABSTRACT FROM AUTHOR]

Objective: To investigate post‐treatment relapse and remission rates 3, 6 and 9 months after completion of an acute phase of a clinician‐supported internet‐delivered cognitive‐behavioural therapy (iCBT) for anxiety and depressive symptoms, within a routine care setting. Method: Secondary analysis from a 12‐month pragmatic randomized‐controlled trial delivered within the Improving Access to Psychological Therapies (IAPT) programme in England. Participants in the intervention arm were included if they met criteria for reliable recovery from depression (PHQ‐9) and anxiety (GAD‐7) at post‐treatment assessment. Survival analysis was used to assess durability of treatment effects and determine predictors to relapse at 3‐, 6‐ and 9‐month follow‐up. Hazard ratios predicting time‐to‐relapse were estimated with semi‐parametric Cox proportional hazards model. Results: Of the 241 participants in the intervention arm, 89 participants met the criteria for reliable recovery from depression and anxiety at the post‐treatment assessment. Of these 89 eligible cases, 29.2% relapsed within the 9‐month period, with 70.8% remaining in remission at 9 months post‐treatment. Of those who relapsed, 53.8% experienced a relapse of depression and anxiety; 7.7% experienced a relapse of depression only; and 38.4% experienced a relapse of anxiety only. Younger age, having a long‐term condition, and residual symptoms of anxiety at end‐of‐treatment were all significant predictors of relapse. Conclusions: This study is the first to explore the remission and relapse rates after an acute phase of iCBT treatment, within a routine, stepped‐care setting. The results add to the scarce literature on the durability of the effects of iCBT treatment in routine care settings, where patients are not typically followed up after receiving a completed course of treatment. [ABSTRACT FROM AUTHOR]

Background: Metacognitive training for depression (D‐MCT) is a novel low‐intensity group training for economic treatment of depression. Previous studies demonstrate its efficacy in moderately depressed outpatients. The present study evaluated efficacy and patients' perspective of the D‐MCT in severely depressed psychiatric inpatients. Methods: In a randomized‐controlled trial, 75 individuals with a major depressive disorder (MDD) were allocated to D‐MCT versus euthymic therapy as add‐on (twice a week) to cognitive‐behavioural‐based (CBT) inpatient‐care. Depressive symptoms (HDRS, BDI), dysfunctional (meta)cognition (DAS, MCQ‐30) and subjective appraisal were assessed at baseline, 4 weeks (post) and 3 months (follow‐up). Results: Participants in both conditions showed a large decline in depression at post and follow‐up‐assessment. No superior add‐effect of D‐MCT versus active control emerged for depression severity on top of the inpatient care. However, among patients with a diagnosis of MDD with no (vs. at least one) comorbidity, D‐MCT participants showed a larger decline in depressive (meta‐)cognition at follow‐up with medium‐to‐large effect sizes. D‐MCT was evaluated as superior in overall appraisal, treatment preference, motivation and satisfaction. Limitations: The follow‐up time interval of 3 months may have been too short to detect long‐term effects. There is emerging evidence that modification of (meta)cognition unfolds its full effects only with time. Effects of CBT inpatient‐care on outcome parameters cannot be differentiated. Conclusions: Although D‐MCT as an add‐on was not superior in complete case analyses, results suggest greater benefit for patients with MDD and no comorbidity. D‐MCT proved feasible in acute‐psychiatric inpatient‐care and was highly accepted by patients. Future studies should investigate the role of modified (meta)cognition on long‐term treatment outcome, including dropout and relapse rates. [ABSTRACT FROM AUTHOR]

Refugees and asylum seekers are exposed to multiple burdensome experiences and suffer from ongoing post‐migration stressors that are known to affect the physical and mental health. In psychological treatment offered to refugees and asylum seekers, dropout is an important challenge. The current practice‐oriented review aims to provide for the first time knowledge on the prevalence, prediction and prevention of dropout in psychological treatment for refugees and asylum seekers. Due to the limited empirical evidence for this specific population, we synthesized refugee‐specific research but also reviewed the existing evidence on dropout from treatment in general and specifically discuss how the findings can be adapted to refugee populations. The review integrates literature from online databases, grey literature, hand search and expert contacts. Prevalence rates of dropout from psychological treatment in Western samples are reported at about 20%. For refugees and asylum seekers, evidence from single efficacy trials showed considerable variability in dropout rates (0%–64.7%). Further, for refugees and asylum seekers, specific sociodemographic variables, high initial impairment, deviating expectations and perceptions of mental health and psychological treatment, as well as external barriers seem to be important predictors for dropout. To prevent dropout, it is important to develop and promote cultural competencies, adapt the treatment to refugee‐specific needs and focus on role induction, preparation for treatment, fostering the therapeutic alliance and strengthening hope. Future specific research on dropout in treatment offered to refugees and asylum seekers is needed. [ABSTRACT FROM AUTHOR]

Background: While the acquisition and application of Cognitive Behaviour Therapy (CBT) skills is a core component and likely mechanism of effect maintenance in all CBT‐based treatments, the extent of post‐therapeutic CBT skills usage among internet‐delivered CBT (iCBT) clients remains under‐researched. Method: Nested within a pragmatic randomized controlled trial, 241 participants received an 8‐week supported iCBT intervention for anxiety and/or depression and answered open‐ended questions about their use and experience of CBT skills at 3‐, 6‐, 9‐, and 12‐month follow‐up. Recurrent, cross‐sectional qualitative analysis following the descriptive and interpretive approach was used to create a taxonomy, through which all qualitative data was coded. Results: In total, 479 qualitative responses across 181 participants were analysed. Participants reported using a wide range of CBT skills and associated helpful and hindering experiences and impacts. The reasons for discontinued CBT skills usage were diverse, ranging from rare adverse effects to healthy adaptation. Conclusion: The study shows how clients receiving iCBT in routine care learn CBT skills during treatment and utilize them in productive ways post‐treatment. Findings coincide with similar research in face‐to‐face CBT and may inform future research to drive innovation and iCBT intervention development. [ABSTRACT FROM AUTHOR]

Objective: Because the therapeutic processes of Avatar Therapy remain equivocal, the current study aims to further extend our previous findings by analysing the evolution of the avatars' and patients' speech and changes in patient responses as sessions progressed. Design Eighteen patients with treatment‐resistant schizophrenia were selected from two clinical trials on Avatar Therapy. Three coders analysed both the avatars' and patients' discourse during immersive therapy sessions using content analysis methods. Results: Our analyses enabled the categorization of the avatar discourse into confrontational techniques (e.g., provocation) and positive techniques (e.g., reinforcement). Patients responded to these utterances using coping mechanism or by expressing emotions, beliefs, self‐perceptions or aspirations. Through identification of mutual changes in the interaction between the patient and their avatar, a shift was observed over the sessions from confrontation to a constructive dialogue. Assertiveness, emotional responses and prevention strategies seemed to be central to the therapeutic process, and these usually occur in response to positive techniques. Conclusion: Investigating AT's therapeutic process may help to identify components to achieve positive outcomes and can enable the development of more effective treatments. Further studies should explore the association between these themes and therapeutic response to help predict which patients will better respond to Avatar Therapy. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore the effects of treatment compliance in a guided individually tailored internet‐based treatment (TAIL) in relation to depression and co‐morbid symptoms. Compliance with the homework in the different treatment components in TAIL, each aimed at a specific condition, was rated for 207 participants by independent assessors. Six subgroups (n = 34–131) were constructed consisting of participants with co‐occurring symptoms of worry, panic, social anxiety, stress, insomnia, or pain. For each group, hierarchical regression was used to investigate whether the total sum of compliance points, Overall Compliance, predicted reductions in depression and in condition‐specific symptoms. Also, in each subgroup, it was tested whether working with specific treatment components, Specific Compliance, predicted reduction of the targeted symptoms. Overall Compliance predicted 15% of the reduction in depression symptoms. For participants with worry, panic, social anxiety, stress, or insomnia, Overall Compliance also predicted symptom reductions in that specific condition. Specific Compliance predicted reduction in the targeted symptoms for participants with social anxiety, stress, and insomnia. Specific Compliance with stress and insomnia components also predicted reductions in depression. Our results strengthen the importance of compliance in internet‐based treatments. Because compliance with stress and insomnia components was particularly important for broad symptom reductions, these conditions should not be ignored when treating patients with co‐morbid symptoms. [ABSTRACT FROM AUTHOR]

Adjustment disorder (AD) and complicated grief (CG) are serious mental conditions that have a high prevalence and are associated with significant impairments in social and work functioning. Recently, these categories have been better specified in the new ICD‐11 proposal. Empirical research on the efficacy of treatments for these problems is scarce. This study aims to offer long‐term efficacy data from a between‐groups controlled study that compares two treatment conditions (AD‐protocol applied in a traditional way: N = 18 and the same protocol supported by virtual reality (VR); VR‐protocol applied in a traditional way: N = 18) and a waiting list (WL) control group (N = 18). Both treatment conditions resulted in statistically significant improvements on both primary and secondary outcome measures, with large effect sizes, and this improvement did not occur in the WL. These changes were maintained in both treatment conditions in the medium (6‐month) and long‐term (12‐month follow‐up). Larger effect sizes were achieved in the VR condition in the long term. Furthermore, clinically significant change estimations on the primary outcome measures showed an advantage for the VR condition This is the first controlled study to compare a traditional face‐to‐face protocol for the treatment of stress‐related disorders with the same protocol supported by VR and a WL control group. [ABSTRACT FROM AUTHOR]

Objective: Although there is sufficient research and clinical evidence to support the inclusion of gaming disorder in the latest revision of the International Classification of Diseases, relatively little is known about the effectiveness of first‐line psychological treatment for gaming disorder or internet gaming disorder (IGD) as it is listed in the Diagnostic and Statistical Manual. This systematic review employed meta‐analytic techniques to determine the effectiveness of cognitive–behavioural therapy (CBT) for IGD on four key outcomes: IGD symptoms, anxiety, depression, and time spent gaming. Method: A database search identified 12 independent CBT studies. Effect size estimates (Hedges' g) with associated confidence intervals, prediction intervals, and p values for each pre–post treatment outcome, were calculated. Study reporting quality was evaluated in accordance with the Consolidated Standards of Reporting Trials guidelines. Subgroup and moderator analyses were undertaken to investigate potential sources of heterogeneity. Results: CBT demonstrated high efficacy in reducing IGD symptoms (g = 0.92; [0.50, 1.34]) and depression (g = 0.80, [0.21, 1.38]), and showed moderate efficacy in reducing anxiety (g = 0.55, [0.17, 0.93]) at post‐test. There was insufficient power to determine whether CBT was capable of reducing time spent gaming. Treatment gains at follow‐up were nonsignificant across the four treatment outcomes. Conclusions: The pooled findings suggest that CBT for IGD is an effective short‐term intervention for reducing IGD and depressive symptoms. However, the effectiveness of CBT for reducing actual time spent gaming was unclear. Given the limitations of this evidence base, there is a need for more rigorous studies to determine the potential long‐term benefits of CBT for IGD. Public Health Significance Statement: Given the rise in treatment demand for internet gaming disorder (IGD) and problematic gaming, it is necessary to determine which treatments are most effective for whom and under which conditions. This review shows that cognitive‐behavioural therapy for IGD, which is often considered the first‐line therapy, can improve IGD symptoms and comorbid depression. However, treatment gains tend to be short‐term and their effect in reducing time spent gaming is unclear. Programs that target problematic gaming may be improved by additional support beyond the standard program of therapy sessions. More funding and resources are needed to support the development of a more rigorous evidence base on IGD and its treatment. [ABSTRACT FROM AUTHOR]

This article presents the theoretical, clinical, and practical arguments supporting a process‐based transdiagnostic approach to psychotherapy. A working definition of "psychological process" is provided, as well as a tri‐dimensional categorization of psychological processes potentially involved in psychopathology. Guidelines are proposed to select psychological interventions based on the active psychopathological processes evidenced in a given case. We also provide a rationale to organize treatment as a set of modules, each addressing a specific psychopathological process. Next, we review the main processes that may be active in mood and anxiety disorders, and that are accessible to clinicians in regular practice. For each process, we propose a validated assessment questionnaire. Finally, we offer a free‐access web‐based instrument that allows clients to fill in these questionnaires via an internet survey, and that provides therapists with a tool to easily decode and interpret the questionnaire results and to present them to the clients. [ABSTRACT FROM AUTHOR]

Emotion regulation (ER) difficulties have been identified as an important target for clinical intervention in the treatment of post‐traumatic stress disorder (PTSD) symptoms in survivors of childhood sexual abuse (CSA). However, there is limited research regarding the use of specific strategies to regulate specific emotions following exposure to traumatic events. The aim of the current study was to investigate the indirect effects of four trauma‐related emotions (anger, sadness, disgust, and fear) on PTSD severity via two mediators: derealization and self‐harm. In particular, we tested that if the two hypothetical mediators operate sequentially, derealization precedes self‐harm and/or self‐harm precedes derealization. A predominate female clinical sample (N = 109) of CSA survivors completed measures of experience of emotions, ER, and post‐traumatic stress. Bivariate and serial mediation analyses were conducted to test the direct and indirect effects of trauma‐related emotions on PTSD severity. Serial mediation analyses indicated that there were significant total effects of all trauma‐related emotions on PTSD severity. Three trauma‐related emotions (sadness, disgust, and fear) were indirectly associated to PTSD severity via derealization and self‐harm and via self‐harm and derealization. Results indicate that difficulties in regulating the emotions of sadness, disgust, and fear may result in more severe derealization and self‐harm as coping strategies, which in turn lead to greater PTSD severity. The sequence of mediators does not hold great importance in these pathways. Overall, our findings suggest that therapeutically targeting derealization and self‐harm might enable the reduction of PTSD among CSA survivors. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioural therapy (CBT) is commonly used to treat cancer patients with psychological disorders such as depression. There has been little qualitative research exploring the experience of therapists delivering CBT to patients with advanced cancer and long‐term health conditions generally. Therapists' views may help identify difficulties in delivering therapy and how these may be overcome. The aim of this study was to inform practice by qualitatively exploring the experiences of therapists delivering CBT to patients with advanced cancer. Design: Sixteen semi‐structured interviews were conducted with therapists from Increasing Access to Psychological Therapy (IAPT) services in London, UK, who had delivered CBT to patients enrolled on the CanTalk trial. Interviews were recorded, transcribed, and analysed using framework analysis. Results: Therapists reported positive experiences when working with the target population. Flexibility, adaptability, and a consideration of individual needs were identified as important when delivering CBT, but the rigidity of IAPT policies and demand for services were perceived as problematic. Although therapists reported adequate training, specialist supervision was desired when delivering therapy to this complex population. Conclusion: IAPT therapists can deliver CBT to advanced cancer patients, given therapists positive experiences evident in the present study. However, it was concluded that additional service and modifications of therapy may be needed before positive outcomes for both therapists and patients can be achieved. [ABSTRACT FROM AUTHOR]

We examine associations between client attachment style and therapeutic alliance in a 3‐arm randomized controlled trial of brief motivational interviewing and cognitive–behavioural therapy compared with longer term motivational interviewing and cognitive–behavioural therapy or standard care alone. Client self‐report measures of attachment style were completed at baseline, and both clients and therapists in the treatment arms of the trial completed alliance measures 1 month into therapy. We found that insecure–anxious attachment was positively associated with therapist‐rated alliance, whereas clients with insecure–avoidant attachment were more likely to report poorer bond with therapist. There was no evidence that client attachment significantly predicted clinical or substance misuse outcomes either directly or indirectly via alliance. Nor evidence that the length of therapy offered interacted with attachment to predict alliance. [ABSTRACT FROM AUTHOR]

The cognitive–behavioural model of hoarding disorder incorporates information processing difficulties, maladaptive attachment to possessions, erroneous beliefs about the nature of possessions, and mood problems as etiologically significant factors, although developmental experiences such as a compromised early family environment have also been proposed in an augmented model. This study examined the specificity and relevance of variables highlighted in the augmented cognitive–behavioural model. Various clinical participants (n = 89) and community controls (n = 20) were assessed with structured clinical interviews to verify diagnosis. Participants completed self‐report measures of hoarding severity, cognitions, meta‐memory, and early developmental experiences (e.g., memories of warmth and security in one's family). Hoarding cohorts (with and without obsessive–compulsive disorder) reported poor confidence in memory, but relative to other groups (obsessive–compulsive disorder without hoarding disorder, anxiety disorders, and healthy controls), hoarding‐relevant cognitions, need to keep possessions in view, and concerns about the consequences of forgetting were significantly higher. Hoarding groups reported the lowest recollections of warmth in their family, although no differences were found between hoarding and non hoarding clinical cohorts for uncertainty about self and others. Nonetheless, clinical cohorts reported generally higher scores of uncertainty than healthy controls. When predicting hoarding severity, after controlling for age and mood, recollections of lack of warmth in one's family was a significant predictor of hoarding severity, with hoarding‐related cognitions and fears about decision‐making being additional unique predictors. The study supports the augmented cognitive–behavioural model of hoarding, inclusive of the importance of early developmental influences in hoarding. [ABSTRACT FROM AUTHOR]

We examined the relationship between psychodynamic techniques early in treatment with reliable change in depressive symptomatology. Forty‐six patients admitted for individual psychodynamic psychotherapy who received a diagnosis representative of a depressive spectrum disorder were assessed pretreatment and posttreatment through self‐report of depressive symptoms. Videotapes from two early treatment sessions (3rd and 9th) were independently rated on the Comparative Psychotherapy Process Scale for use of psychodynamic‐interpersonal and cognitive–behavioural techniques, with excellent interrater reliability (intraclass correlation coefficient > .75). We found a significant relationship between overall use of psychodynamic technique across early treatment (r = .31, p = .036), as well as specific psychodynamic techniques delivered across early treatment, with change in patient‐reported depressive symptoms. Our findings suggest that focusing on affective experiencing and expression, as well as providing interpretations are particularly helpful early in psychodynamic treatment for depression. Clinical implications and future directions are discussed. [ABSTRACT FROM AUTHOR]

The assimilation model describes therapeutic change as an integration of experiences that had previously been problematic, distressing, avoided, or warded off. This study assessed whether assimilation was associated with treatment outcome in a sample of psychotherapeutic treatments for depression. Further, it assessed the direction of the association—whether increasing assimilation predicted decreases in symptom intensity or decreasing symptom intensity predicted increases in assimilation. Method: Participants were 22 clients with mild to moderate depression drawn from a clinical trial comparing cognitive behavioral therapy with emotion‐focused therapy. The direction of prediction between assimilation progress and changes in self‐reported symptom intensity was assessed. Results: The assimilation progress was shown to be a better predictor of decreases in symptom intensity than the reverse. Conclusion: The results supported the assimilation model's suggestion that assimilation progress promotes decreases in symptom intensity in the treatment of clients with major depressive disorder. [ABSTRACT FROM AUTHOR]

Committed action, a process of acceptance and commitment therapy's psychological flexibility model, is considered an understudied construct that currently can only be measured by one instrument, the Committed Action Questionnaire (CAQ‐8). This study aims at analysing the psychometric properties of the CAQ‐8 in healthy individuals and breast cancer patients. This study also aims to explore the specific meditational role of committed action in the well‐established relationship between experiential avoidance and depression symptoms. The healthy sample comprised 294 adults from the general population, and the breast cancer samples comprised 82 participants. Both groups completed the validated self‐report measures. CAQ‐8's robustness was examined through validity analyses, confirmatory factor analyses, and multigroup analysis. The meditational model was conducted using structural equation modelling. The CAQ‐8 presented good internal consistency and construct, convergent, concurrent, and divergent validity in both samples. Further, the CAQ‐8 showed incremental validity over a measure of engaged living. Findings also demonstrated measurement invariance between healthy individuals and breast cancer patients. Regarding the conducted meditational model that was also invariant between the two analysed groups, it was demonstrated that part of the effect that experiential avoidance holds on depressive symptomatology is explained by committed action. This study suggests that the CAQ‐8 is adequate for use in healthy and cancer populations. Moreover, it provides novel, empirical support regarding the links between committed action, experiential avoidance, and depressed mood, being also the first investigation to particularly study committed action in a cancer population. Implications for theory and practice are discussed. [ABSTRACT FROM AUTHOR]

Objectives We investigated the feasibility and acceptability of an integrated group therapy (called HABIT) for comorbid bipolar disorder (BD) and alcohol and substance use disorders (ASUD) (BD-ASUD), a disabling clinical presentation for which no specific treatment has been validated. The 14-session HABIT programme employs psychoeducation-oriented cognitive-behaviour therapy (CBT) followed by mindfulness-based relapse prevention (MBRP) therapy. Method Potential group participants were recruited from adult clients with a DSM-IV diagnosis of BD and an ASUD who were referred by their treating clinician. Observer-rated changes in mood symptoms and ASUD, attendance rates and subjective feedback are reported. Results Eight of 12 clients referred to the programme initially agreed to join the group, six attended the first group session and five clients completed the programme. Group mean scores for mood symptoms improved over time, with slightly greater reductions in depression during the first module. About 50% of individuals showed clinically significant improvement (≥30% reduction) in alcohol and substance use. Attendance rates showed some variability between individuals and across sessions, but the average attendance rate of the group was marginally higher for the first module (86%) as compared with the second module (77%). Most clients reported high levels of general satisfaction with a group specifically targeted at individuals with BD-ASUD. Conclusion This small pilot study suggests our intensive group therapy is acceptable and feasible. If findings are replicated, we may have identified a therapy that, for the first time, leads to improvement in both mood and substance use outcomes in clients with difficult-to-treat comorbid BD-ASUD. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Comorbidity between bipolar and alcohol and substance use disorders (BD-ASUD) is frequent and highly disabling;, Therapeutic research on approaches that can simultaneously help BD and ASUD is lacking;, Previous research highlights the need for integrated treatment of both conditions but showed improvements limited to either element of the comorbid disorder;, This pilot study supports the feasibility and acceptability of an intensive, 14-session group therapy programme that integrates CBT and mindfulness approaches. [ABSTRACT FROM AUTHOR]

There has been limited research on therapeutic alliance in the context of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) when delivered in clinical practice. The present study investigated therapeutic alliance in ICBT delivered to patients seeking treatment for symptoms of depression ( n = 83) or generalized anxiety ( n = 112) as part of an open dissemination trial. ICBT was provided by 27 registered therapists or 28 graduate students working in six geographically dispersed clinics; therapist-assistance was delivered primarily through secure messages and occasionally telephone calls. The Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were collected pre-, mid- and post-treatment, and the Therapeutic Alliance Questionnaire was assessed mid- and post-treatment. Therapeutic alliance ratings were high both at mid-treatment and post-treatment (above 80%). There was no relationship between therapeutic alliance ratings and improvement on primary outcomes. Among patients treated for depression, lower ratings of mid-treatment alliance were associated with concurrent treatment by a psychiatrist and fewer phone calls and emails from their therapist. Among patients treated for generalized anxiety, ratings of mid-treatment alliance were higher among registered providers as compared to graduate students. Multiple directions for future research on therapeutic alliance in ICBT are offered, including suggestions for developing a new measure of therapeutic alliance specific to ICBT and measuring therapeutic alliance throughout the treatment process. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message This research demonstrated that therapeutic alliance ratings were very strong at both mid- and post-treatment among patients who received Internet-delivered cognitive behaviour therapy (ICBT) for depression or anxiety in clinical practice., Among patients receiving ICBT for depression, lower ratings of therapeutic alliance were associated with patients reporting concurrent treatment by a psychiatrist and with the receipt of fewer phone calls and emails from the therapist., Among patients receiving ICBT for generalized anxiety, ratings of alliance were higher when patients were treated by registered providers as compared to graduate students., Therapeutic alliance ratings did not predict outcome in ICBT for depression or anxiety., Practitioners have reason to be confident that a therapeutic relationship can be formed in ICBT when delivered in clinical practice. [ABSTRACT FROM AUTHOR]

Exploration of the patient-therapist relationship (transference work) is considered a core active ingredient in dynamic psychotherapy. However, there are contradictory findings as for whom and under what circumstances these interventions are beneficial. This study investigates long-term effects of transference work in the context of patients' quality of object relations (QOR) and therapists' self-reported disengaged feelings. Therapists' disengaged feelings may negatively influence the therapeutic process, especially while working explicitly with the transference since discussing feelings that are present in the session is an essential aspect of transference work. One hundred outpatients seeking psychotherapy for depression, anxiety and personality disorders were randomly assigned to one year of dynamic psychotherapy with transference work or to the same type and duration of treatment, but without transference work. Patients' QOR-lifelong pattern was evaluated before treatment and therapists' feelings were assessed using the Feeling Word Checklist-58 after each session. Outcome was measured with self-reports and interviews at pre-treatment, mid-treatment, post-treatment, one year and three years after treatment termination. A significant interaction of treatment group (transference work versus no transference work) by QOR by disengaged therapist feelings was present, indicating that disengaged feelings, even small amounts, were associated with negative long-term effects of transference work, depending on QOR Scale scores. The strengths of the negative association increased significantly with lower levels of QOR. The negative association between even a small increase in disengaged therapist feelings and long-term effects of transference interpretation was substantial for patients with poor QOR, but small among patients with good QOR. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Therapists' emotional reactions to their patients (countertransference) seem to have a significant impact on both the treatment process and outcome of psychotherapy., Therapists' heightened level of disengaged feelings over a treatment period shows an adverse impact on the effect of transference work for all patients, and especially so for patients with a history of poor, non-mutual and complicated relationships., For patients with a history of reciprocal, sound relationships the negative influence of therapists' disengaged countertransference is minimal., Higher therapist disengagement is strongly related to inferior therapists' skill for patients with a history of poor relationships and/or more personality disorder pathology., Training and supervision should provide direct feedback and focus on therapists' internal thought processes and emotional reactions., Therapists need to recognize and understand their feelings and attitudes in order to use the countertransference as a tool to understand the interpersonal process in therapy. [ABSTRACT FROM AUTHOR]

The study aim was to test whether a 12-week publically rebated group programme, based upon Steketee and Frost's Cognitive Behavioural Therapy-based hoarding treatment, would be efficacious in a community-based setting. Over a 3-year period, 77 participants with clinically significant hoarding were recruited into 12 group programmes. All completed treatment; however, as this was a community-based naturalistic study, only 41 completed the post-treatment assessment. Treatment included psychoeducation about hoarding, skills training for organization and decision making, direct in-session exposure to sorting and discarding, and cognitive and behavioural techniques to support out-of-session sorting and discarding, and nonacquiring. Self-report measures used to assess treatment effect were the Savings Inventory-Revised (SI-R), Savings Cognition Inventory, and the Depression, Anxiety and Stress Scales. Pre-post analyses indicated that after 12 weeks of treatment, hoarding symptoms as measured on the SI-R had reduced significantly, with large effect sizes reported in total and across all subscales. Moderate effect sizes were also reported for hoarding-related beliefs (emotional attachment and responsibility) and depressive symptoms. Of the 41 participants who completed post-treatment questionnaires, 14 (34%) were conservatively calculated to have clinically significant change, which is considerable given the brevity of the programme judged against the typical length of the disorder. The main limitation of the study was the moderate assessment completion rate, given its naturalistic setting. This study demonstrated that a 12-week group treatment for hoarding disorders was effective in reducing hoarding and depressive symptoms in an Australian clinical cohort and provides evidence for use of this treatment approach in a community setting. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message A 12-week group programme delivered in a community setting was effective for helping with hoarding symptoms with a large effect size., Hoarding beliefs (emotional attachment and responsibility) and depression were reduced, with moderate effect sizes., A third of all participants who completed post-treatment questionnaires experienced clinically significant change., Suggests that hoarding CBT treatment can be effectively translated into real-world settings and into a brief 12-session format, albeit the study had a moderate assessment completion rate. [ABSTRACT FROM AUTHOR]

The Behavioral Activation for Depression Scale (BADS) was developed to measure core concepts of behavioural activation for depression. A number of studies, mostly based on analogue samples, have provided initial support for the BADS. In the present study, we examined the psychometric properties of the German version of the scale more broadly, including change sensitivity and clinical treatment data. A mixed sample of students ( N = 312) and depressed outpatients in partial remission undergoing cognitive-behavioural group treatment for depressive rumination ( N = 59) was examined. To analyze construct validity, a set of theoretically relevant constructs such as perseverative thinking, distraction and mindfulness was also assessed. Results indicated good psychometric properties, additional evidence for construct validity of the total scale and subscales, and adequate fit of the data to the original factor structure. Furthermore, the BADS proved to be sensitive to changes in participants undergoing treatment for depression. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Behavioural activation (BA) is an effective treatment for patients suffering from unipolar depression., The Behavioral Activation for Depression Scale (BADS) can be used to measure core elements of the BA treatment rationale. It is useful to track changes in activation within treatment., The BADS is available in different languages and has shown to possess good psychometric properties. [ABSTRACT FROM AUTHOR]

The present study examines a more fine-grained analysis of anxiety-related and depression-related outcomes amongst a sample of treatment completers who were assigned to complicated grief treatment (CGT) ( n = 35) or interpersonal psychotherapy (IPT) ( n = 34) in a previously reported randomized controlled trial. We examined effects of antidepressant use and measures of anxiety and depression, focusing especially on guilt related to the death or deceased and grief-related avoidance in order to further understand the differential effectiveness of CGT and IPT amongst participants who received the full course of treatment. Analyses showed that CGT produced greater reductions in anxiety and depressive symptoms including negative thoughts about the future and grief-related avoidance. CGT's advantage over IPT in lowering depression was most pronounced amongst those not taking antidepressants. Our results further elucidate CGT effects and support the idea that CG and major depressive disorder are distinct conditions. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Targeted treatment for complicated grief (CG) produces benefits in associated mood and anxiety symptoms and CG symptoms., Amongst patients with CG, interpersonal psychotherapy seems relatively ineffective in ameliorating depressive symptoms., Grief-related depressive symptoms may not respond to standard treatments unless CG symptoms are also addressed., Reducing grief-related symptoms, such as anxieties about the future, guilt related to the death or deceased and avoidance of reminders of the loss may be important aspects in reducing CG. [ABSTRACT FROM AUTHOR]

Although cognitive interventions for obsessive-compulsive disorder (OCD) have been tested in randomized trials, there are few trials that have tested the specific mechanisms of cognitive interventions, i.e. how they achieve their effects. In this study, we aimed to investigate the mediating effects of a short cognitive intervention in the treatment of OCD and used data from a recently conducted randomized controlled trial where 101 participants were allocated to either Internet-based CBT (ICBT) or to a control condition. Obsessive beliefs were measured at pre-treatment, at the time they had received the cognitive intervention, and also at post-treatment. Weekly OCD symptoms were measured throughout the 10 weeks of treatment. We hypothesized that (1) the ICBT group would have greater reductions in obsessive beliefs (controlling for change in OCD symptoms) after completing the cognitive intervention, and that (2) this reduction would, in turn, predict greater OCD symptom reduction throughout the rest of the treatment period. Contrary to our expectations, the longitudinal mediation analysis indicated that (1) being randomized to ICBT actually increased the degree of obsessive beliefs after receiving the cognitive intervention at weeks 1-3, and (2) increase in obsessive beliefs predicted better outcome later in treatment. However, when repeating the analysis using cross-sectional data at post-treatment, the results were in line with the initial hypotheses. Results were replicated when the control condition received ICBT. We conclude that, although obsessive beliefs were significantly reduced at post-treatment for the ICBT group, early increase rather than decrease in obsessive beliefs predicted favourable outcome. [ABSTRACT FROM AUTHOR]

Empirical evidence for the effectiveness of long-term psychodynamic psychotherapy (LTPP) in patients with mood disorders is growing. However, it is unclear whether the effectiveness of LTPP is due to distinctive features of psychodynamic/psychoanalytic techniques or to a higher number of sessions. We tested these rival hypotheses in a quasi-experimental study comparing psychoanalytic therapy (i.e., high-dose LTPP) with psychodynamic therapy (i.e., low-dose LTPP) and cognitive-behavioural therapy (CBT) for depression. Analyses were based on a subsample of 77 subjects, with 27 receiving psychoanalytic therapy, 26 receiving psychodynamic therapy and 24 receiving CBT. Depressive symptoms, interpersonal problems and introject affiliation were assessed prior to treatment, after treatment and at the 1-, 2- and 3-year follow-ups. Psychoanalytic techniques were assessed from three audiotaped middle sessions per treatment using the Psychotherapy Process Q-Set. Subjects receiving psychoanalytic therapy reported having fewer interpersonal problems, treated themselves in a more affiliative way directly after treatment and tended to improve in depressive symptoms and interpersonal problems during follow-up as compared with patients receiving psychodynamic therapy and/or CBT. Multilevel mediation analyses suggested that post-treatment differences in interpersonal problems and introject affiliation were mediated by the higher number of sessions, and follow-up differences in depressive symptoms were mediated by the more pronounced application of psychoanalytic techniques. We also found some evidence for indirect treatment effects via psychoanalytic techniques on changes in introject affiliation during follow-up. These results provide support for the prediction that both a high dose and the application of psychoanalytic techniques facilitate therapeutic change in patients with major depression. [ABSTRACT FROM AUTHOR]

Well-being is now defined in a number of multicomponent ways. One approach to defining well-being-psychological well-being (PWB; Ryff, )-encompasses six dimensions of positive functioning. This study's first aim was to compare PWB self-report scores from a group of depressed participants ( N = 26) with a non-depressed group ( N = 26). The second aim was to examine anticipated well-being, specifically, how the positive events people anticipate in the future are seen as being related to various aspects of their well-being. Participants completed the self-report scales of PWB and a task which elicited events participants were looking forward to in the future and their thoughts about what was good about those events. Responses about the value of the events were independently coded for the presence of the six PWB dimensions. The depressed group scored significantly lower on all dimensions of self-reported PWB than the control group, with particularly marked deficits on environmental mastery and self-acceptance. For anticipated events, positive relations with others was the most commonly present aspect of PWB in participants' responses about what was good about the events. The frequency of PWB dimensions present in participants' responses was similar between the two groups with the exception of the depressed group having more self-acceptance related responses and fewer positive relationship responses. The well-established lack of positive anticipation found in depressed individuals is likely to mean a diminished resource for a wide range of aspects of well-being but especially positive relationships with others. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message The treatment of depression is thought to be more effective when it enhances psychological well-being as well as reducing dysfunction., In the present study, all dimensions of psychological well-being were lower in depressed participants with particularly marked deficits in environmental mastery and self-acceptance, suggesting that these may be particularly important treatment targets., People with depression show specific deficits in being able to anticipate future positive events., The present study suggests that anticipated well-being linked to positive relationships with other people may be particularly impacted by the lack of anticipated future events found in depression. [ABSTRACT FROM AUTHOR]