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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]

Therapists working with people who have complex problems associated with psychosis may find it difficult to apply currently available cognitive behavioural therapy (CBT) manuals to client's presenting problems. This can lead to activation of negative therapist beliefs about themselves, the client or the therapy and subsequent problems maintaining the therapeutic relationship. This paper describes the integration of a range of models and concepts derived from CBT which were used to assist one such client with complex problems associated with psychosis. As such, it is proposed that taking a flexible, formulation driven approach to therapy can assist therapists to remain client centred and work effectively. The therapy described draws on a number of concepts including those taken from schema focussed therapy, mindfulness and compassionate mind training. Therapist and client summary letters were used as part of the described intervention, but in addition, the client's summary is reproduced in the paper aiming to address the issue of the under reporting in the literature of the client's perspective on therapy. Copyright © 2011 John Wiley & Sons, Ltd. [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]

This review draws attention to the broad and diverse theoretical underpinnings of interpersonal psychotherapy (IPT). A plea is made for greater attention to the theoretical influences on IPT in forming our understanding of the techniques and processes and to establish indicators of successful outcome as well as for whom the treatment is most suitable. The paper takes a lifespan perspective that considers the implications of social factors for the different age groups to which IPT has been shown to be effective in the treatment of depression. The main thrust of the paper considers the potential importance of social theory, particularly the research on life events and social support. It is argued that it is these social aspects and particularly a focus on the use of the patient's wider social network that distinguishes IPT from other evidence-based short-term therapies. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message [ABSTRACT FROM AUTHOR]

This paper shows the convergence of voices in psychotherapy in the context of the assimilation model. Convergence is the link between patients' voices within the community of voices. The main aim of the paper was to explore (a) how convergence (and divergence) is shown during sessions and the usefulness of convergence for the process of assimilation; (b) if a well-structured patient is able to track the sociohistorical antecedents of his/her main voices; and (c) if, at the end of the therapy, the self becomes richer and with more resources. For this aim to be realized, a case study of a patient, María, treated with linguistic therapy of evaluation for 14 sessions, was analysed by using the Assimilation of Problematic Experiences Scale (APES). Three main problematic experiences or non-dominant voices were identified with the APES: inability to do things, dizziness and tiredness. María's main dominant voices were to cure, solve and overcome problems, to be always doing things and to cope. Results showed a convergence but no divergence of voices as early as session 3. Results also showed how continuity-benevolence assumptions were broken and that, at the end of therapy, the patient's self became richer due to assimilation through the dialogue between non-dominant and dominant voices. Discussion emphasized these results, which are especially representative of a well-integrated patient who showed a healthy multiplicity. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The goal of this paper is to show (i) how the moment-to-moment tracking and processing of emotion to completion —in an emotionally engaged patient–therapist dyad where the individual feels safe and known—constitutes a powerful mechanism of therapeutic transformation, and (ii) how positive emotions are sensitive affective markers of that transformational process. Evidence from transformational studies is used to elaborate the vital role of positive emotions in the process of change in general, and, more specifically, in the course of therapeutic work with painful and overwhelming emotional experience. It is proposed that these emergent positive emotions are affective markers which signal the operation of healing transformational processes in psychotherapy. Several types of positive emotion that arise spontaneously during moment-to-moment experiential therapeutic work will be described and their role as markers of different transformational processes will be elucidated. The paper begins with examples of clinical work with emotion in AEDP (Accelerated Experiential–Dynamic Psychotherapy), an emotion-focused and attachment-based model of therapy that places the dyadic regulation of affect at the centre of both theory and practice. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The present paper deals with a developing training element in cognitive behaviour therapy (CBT), the self-practice of therapeutic techniques and the self-exploration of the person of the therapist. Initially, the current status of this training element in CBT is discussed, and a short note on its terminology is presented. Then an overview of the most important objectives of self-practice and self-reflection in CBT, and the concepts and methods of practice of this element is given. The concepts focus on two major aims, the self-exploration of the person of the therapist within and beyond his or her therapeutic practice, and the self-application of therapeutic techniques (= self-practice). In the second part of the paper empirical studies related to the outcome of self-reflection and self-practice on the development of the therapist and her or his therapeutic practice are reviewed. The few empirical studies show that trainees experience in their own view substantial professional and personal gains from this training tool, with the professional impact being more important than the personal one. The most important outcomes evaluated by subjective data from the trainees are improvements in self-insight and self-awareness and a better understanding of the therapist's role and the therapeutic change process. Additionally, a better understanding of CBT methods and of general therapeutic skills, such as empathy and role-taking-competencies, are reported by the trainees. The paper comes to the conclusion that self-exploration and self-practice are important components of CBT training. Consequences and recommendations for its integration into training courses for CBT are discussed as well as the necessity for more research in this area. Copyright © 2002 John Wiley & Sons, Ltd. [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]

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]

This introductory paper for the Special Series on Post-traumatic Stress Disorder (PTSD) provides an overview of the psychological literature on chronic PTSD. We describe the symptoms of PTSD, the common associated features of the disorder, and common themes in the clinical presentation of traumatized individuals. Epidemiological studies are reviewed that reveal the widespread occurrence of potentially traumatizing events and the prevalence of PTSD among traumatized populations. We next provide an overview of psychological assessment procedures. This is followed by a description of three psychological theories of PTSD that have received a good deal of attention along with their implications for treatment. Two of the most widely applied treatments of PTSD are next reviewed in some detail: direct therapeutic exposure therapy and stress management approaches. Finally, we introduce the six papers that follow in the series in the context of a brief discussion of directions for future research in the field of chronic PTSD. [ABSTRACT FROM AUTHOR]

Depression is highly prevalent and debilitating among medically ill patients. As high as one third of the primary practise patients screen positive for depression symptoms and over half of the patients diagnosed with major depressive disorder are treated in primary care. However, current primary care service arrangements do not efficiently triage patients who screen positive for depression into appropriate treatments that reflect their individual needs and preferences. In this paper, we describe a tool that aims to fill the gap between screening the patients for depression and triaging them to appropriate care. This is a three-session adaptation of interpersonal psychotherapy: ipt; evaluation, support, triage (IPT-EST). We first outline IPT-EST procedures that aim to provide structure and content to primary care practitioners who identify patients with positive depression symptoms, thus assisting the practitioners to explore the patients' psychosocial triggers of depression, give basic strategies to manage these interpersonal stressors and provide decisions tools about triaging patients with severe/persistent depression into appropriate treatment. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message [ABSTRACT FROM AUTHOR]

A randomized controlled trial is reported in which three treatments were compared for the management of depression in Primary Care. The treatments were Treatment As Usual (TAU) carried out by the General Practitioners, Cognitive-Behaviour Therapy (CBT) or Interpersonal Psychotherapy (IPT). Measurements of depressive symptomatology were taken at Baseline (Time1), at end of treatment (Time2), and at 5-month follow-up (Time3). An initial analysis of the longitudinal data revealed that there were a significant number of missing values, especially in the Time3 follow-up for the TAU group. That is, the missing data were not missing at random within the dataset, which is one of the considerations for usual procedures for replacement of missing values (RMV). The paper presents, therefore, the outcome of different approaches to RMV and their consequences for conclusions about the relative efficacy of the treatment conditions. The results showed that clients in all conditions improved significantly, with at least some analyses showing superiority of IPT and CBT at end of treatment Time 2. However, by the follow-up clients in all conditions performed equally well. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Although comorbid substance use is a common problem in bipolar disorder, there has been little research into options for psychological therapy. Studies to date have concentrated on purely cognitive-behavioural approaches, which are not equipped to deal with the ambivalence to change exhibited by many towards therapy designed to change substance use. This paper provides the first report of an integrated psychological treatment approach for bipolar disorder with comorbid substance use. The intervention reported combines motivational interviewing and cognitive-behavioural therapy to address ambivalence and equips individuals with strategies to address substance use. Across five individual case studies, preliminary evidence is reported to support the acceptability and the feasibility of this approach. Despite most participants not highlighting their substance use as a primary therapy target, all but one exhibited reduced use of drugs or alcohol at the end of therapy, sustained at 6 months' follow-up. There was some evidence for improvements in mood symptoms and impulsiveness, but this was less clear-cut. The impact of social and relationship issues on therapy process and outcome is discussed. The implications of the current findings for future intervention research in this area are considered. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message [ABSTRACT FROM AUTHOR]

This paper presents a series of cases to explore the development and value of a form of relating therapy for people who hear voices. The therapy is theoretically underpinned by Birtchnell's Relating Theory and offers a therapeutic space where hearers can explore and seek to change the relationship with their predominant voice. Five cases are presented to illustrate the processes of: (1) exploring similarities between relating to the voice and relating socially; (2) enhancing awareness of reciprocity with the voice–hearer relationship; and (3) using assertiveness training and empty chair work to facilitate change. Results were encouraging as change in control and/or distress was apparent for four of the cases. Changes in patterns of relating to voices were also apparent. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Cognitive–behavioural therapy can lead to significant improvements in relapse and inter-episode functioning for individuals with an established course of bipolar disorder. Both psychiatric and psychological models of bipolar disorder suggest that there may be additional benefits in offering this approach earlier in the illness course. This paper reports on the application of a modified cognitive–behavioural approach for individuals after first diagnosis of bipolar disorder using a single case approach across seven participants. Evidence is reported for improvements in mood symptoms and hopelessness following treatment, as well as increased self-control behaviours, more stable activity patterns and increased ability to detect and coping with early warning signs. Implications of these initial findings for future research are discussed. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper presents a single case study, which outlines the innovative application of a new approach to working with a complex clinical case, for whom all other forms of therapy, including drug therapy, psychoanalytic therapy, hypnotism and traditional CBT interventions, had been found to be ineffective. It describes the use of Jeffrey Young's Schema Mode Therapy in the treatment of a 47 year old man with a 30 year history of chronic agoraphobia. The results obtained in terms of the clinical outcome of this single case study are very encouraging and indicate that Schema Mode Therapy may indeed be an effective form of therapy for certain types of complex case, for which more traditional approaches have been unsuccessful. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper proposes a new strategy for bridging the gap between psychotherapy process research and practice. Constructs covering the full spectrum of potential change mechanisms are derived from a general theory of human functioning (Grawe's Consistency Theory) and operationalized by Therapy Spectrum Analysis (TSA), a measure of the realization of therapeutic change mechanisms within individual therapy sessions. Using the data generated by TSA, we conducted an exploratory search for meaningful patterns of process and session-outcome variables using Answer Tree as a context-sensitive method of data analysis. Results show that process-activated resources of the patients, in particular their responsiveness to interventions and motivation are especially predictive of the session productivity experienced. Further analyses were conducted to uncover how the patients' participation can be promoted and results translate into guidelines for the session-to-session decisions by clinicians. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The present paper reviews what is currently known about sexual abuse and the treatment of the offenders. Sexual offending is primarily committed by males and as many as 50% of females and 33% of males are sexually victimized in some way during their life. While some of these acts involve minimally intrusive behaviours (e.g. exhibitionists), many involve forced vaginal or anal intercourse and varying degrees of associated physical violence and deliberate humiliation of the victim. The effects on the victim can be severe and long-lasting. Current theories of the aetiology of these behaviours incorporate biological and developmental factors occurring within a socio-cultural context that fails to discourage sexual abuse. Experience is said to create a vulnerability that in some men finds expression in sexually abusive behaviour. Appropriate assessment targets the issues that are addressed in treatment, including: cognitive distortions, sexual behaviours and attitudes, social functioning and substance abuse. In addition, treatment also attempts to generate a set of relapse prevention plans for each offender. While some reports have not found benefits for treatment, the majority of acceptable studies have demonstrated clear reductions in re-offending among treated sexual offenders. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper describes a pilot study of a 1-year multi-modal treatment for incest survivors, incorporating individual psychotherapy, group psychotherapy, and pharmacotherapy. The treatment was designed to provide a therapeutic context in which the affective intensity and meaning originally attached to the traumatic experience could be tolerated, and in which a thoughtful, reflective construction of the impact of the trauma could be developed. PTSD symptoms decreased in all participants, with all but one no longer meeting the diagnosis at post-treatment and follow-up. Using a narrative methodology, maladaptive schemas and overwhelming affects, 'trauma themes', were also assessed to understand the survivors' views about themselves, others and the world around them. Participants demonstrated a steady pattern of improvement in the resolution of trauma themes. A discussion of the complex posttraumatic response to incest is included, as is a brief description of the treatment. [ABSTRACT FROM AUTHOR]

Despite the proven efficacy of exposure techniques for the treatment of Post-Traumatic Stress Disorder, some obstacles can arise that interfere with successful implementation of exposure-based therapy. In this paper, the theory behind exposure therapy for PTSD is reviewed and basic implementation procedures are detailed. The ways in which three obstacles to treatment (extreme anger, emotional numbing, and overwhelming anxiety) can impede progress in therapy are discussed in terms of theory and case examples. Specific suggestions for circumventing these obstacles are offered, including modifying the exposure techniques and augmenting exposure by using stress inoculation techniques or cognitive therapy. [ABSTRACT FROM AUTHOR]

This paper describes a programme for inpatients with severe personality disorders as well as acute exacerbation of Axis II pathology. The goal of the programme was to quickly stabilize participants with respect to self-injurious behaviour and return them to the community. The programme consisted of frequent coordinated cognitive group therapy sessions with supporting written and audiovisual materials. The groups were open-ended and heterogenous, and employed educational and experiential-affective components. An extended group case example is presented in order to illustrate the operation of the programme. The range of typical participants is described, including their diagnoses, treatment plans, and homework assignments. Some comments on the personal and professional difficulties encountered by therapists working with this population ate described as well as some suggestions for alleviating those difficulties. [ABSTRACT FROM AUTHOR]

This paper reviews several published reports of behavioural and cognitive behavioural treatments of Post Traumatic Stress Disorder (PTSD). It is shown that, despite slightly different mixes of ingredients, these show broad similarities in approach. Two main categories of treatment can broadly be distinguished: Anxiety Management Techniques (AMT) and Direct Therapeutic Exposure (DTE). The principles on which DTE is based may, it is argued, be understood in ways already outlined in Pavlovian Conditioning. A new model, the CEASE Model, is proposed which effectively describes the sequence in which these processes operate over the course of the development and subsequent treatment of PTSD. Many case reports and controlled studies are evaluated and it is shown that these indicate the success of treatment approaches that have as their basis the C E A S E Model. [ABSTRACT FROM AUTHOR]