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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]

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]

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]

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]

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]

This pilot study reports the outcome of cognitive behaviour therapy for panic disorder augmented by panic surfing. This treatment approach encourages acceptance of feelings rather than control of symptoms and anxiety, at the same time also targeting catastrophic misinterpretations, bodily vigilance and safety-seeking behaviours. Eighteen participants completed a brief group treatment for panic disorder incorporating psychoeducation, panic surfing, interoceptive exposure, graded exposure and cognitive restructuring. Significant improvements occurred over the course of this treatment and were maintained at a 1-month follow-up. Results suggest that cognitive behaviour therapy augmented by panic surfing may be effective in the treatment of panic disorder, but there is a need for controlled studies and investigation of the relative contribution of its various components. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study examines the clinical utility of cognitive behavioural therapy delivered via videoconferencing for bulimic disorders, and factors associated with adjustment to this mode of treatment delivery. A single-case-series design was used with six participants with bulimic disorders. Most were living in remote areas in north-east Scotland or Shetland. Therapy sessions were conducted weekly at a bandwidth of ISDN 6 (384 kbytes/sec) via videoconferencing links between local community hospital sites and the eating disorders service in Aberdeen, Scotland. Almost all participants rated high levels of therapeutic alliance and satisfaction with video therapy. Some participants preferred video therapy due to feeling less self-conscious and intimidated, whereas others felt it was less personal than face-to-face sessions would be. It is proposed that video therapy may be particularly suited to the treatment of eating disorders, especially for those with high levels of shame and body-related self-consciousness and those who require greater levels of control in therapy. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]