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Objectives: Compassion‐focused therapy (CFT) has shown promise as a treatment for a number of clinical presentations; however, existing studies have not adequately addressed issues of treatment fidelity. The aims of the present study were to identify initial candidate items that may be included in a CFT therapist competence rating scale and to develop the behavioural indicators to anchor these items. Design: The Delphi method was used to develop and operationalize the competencies required for inclusion in a CFT therapist competence rating scale over five rounds. Methods: Face‐to‐face meetings with two CFT experts were conducted in rounds one, two, and five, and these were used to define and operationalize the competencies. Nine other CFT experts were invited to complete online surveys in rounds two and four. An 80% consensus level was applied to the online surveys. Results: The resulting Compassion Focused Therapy Therapist Competence Rating Scale (CFT‐TCRS) consisted of 23 competencies which were separated into 14 'CFT unique competencies' and nine 'Microskills'. There was high agreement about the included 'CFT unique competencies' and 'Microskills'; however, there were some differences in opinion about the specific content of some items. Conclusions: This is the first study that has attempted to reach consensus regarding the competencies and behavioural anchors for a CFT therapist competence rating scale. The next stage of development for the CFT‐TCRS is to establish whether the scale can be reliably and validly used to evaluate CFT practice. Practitioner points: The Compassion Focused Therapy Therapist Competence Rating Scale (CFT‐TCRS) is the first scale to operationalize the unique and generic competencies required to deliver compassion‐focused therapy (CFT).The CFT‐TCRS can be used as a learning guide for delivering CFT training and with further development could be used to assess therapist competence for CFT training courses, clinical practice, and treatment fidelity in research trials. [ABSTRACT FROM AUTHOR]

Purpose: Rewind is a trauma-focussed exposure technique that is part of Human Givens (HG) therapy. However, there have been no controlled studies examining the effectiveness or acceptability of Rewind, and a previous study comparing HG therapy outcomes with cognitive behaviour therapy (CBT) benchmarks has yet to be replicated. The paper aims to address these issues. Design/methodology/approach: This preliminary investigation used an observational, quasi-experimental design. Using both between-subject and within-subject designs, the outcome measures of those who had Rewind in the second session and participants who had treatment-as-usual (TAU) in the second session followed by Rewind in the third session were compared. Pre–post treatment scores were used to evaluate the overall HG therapy and to compare with benchmarks. Findings: Rewind was more effective than control treatment sessions, with 40 per cent recovered and 57 per cent having reliably improved or recovered after the Rewind treatment session. Rewind sessions were rated as acceptable as other treatment sessions. The effect size of HG therapy was above the CBT Clinical Outcomes in Routine Evaluation Outcome-10 (CORE-10) benchmark of 1.22. The recovery rate for treatment completers was 63 per cent, with 91 per cent recovered or reliably improved and was equivalent to the top quartile of services. Practical implications: Rewind is a promising alternative trauma treatment, as people need not discuss details of the trauma, multiple traumas can be treated in one session and fewer treatment sessions may be needed. Originality/value: There are few HG studies reported in the peer-reviewed literature. This preliminary study is the first controlled study of Rewind. The findings are also in line with previous research on HG therapy. [ABSTRACT FROM AUTHOR]

Purpose: Human Givens (HG) Rewind technique is a graded trauma-focused exposure treatment for post-traumatic stress disorder and trauma. The purpose of this paper is threefold: first, to describe the technique; second, to provide an outline of its potential benefits; and third, to present some preliminary evidence. Design/methodology/approach: This paper provides an overview of HG therapy and describes the stages of HG Rewind trauma treatment and its potential benefits. Similarities and differences between Rewind and other Cognitive Behavioural Therapy techniques are explored. Possible underlying mechanisms are discussed. Findings: Preliminary evidence suggests that Rewind could be a promising trauma treatment technique and that HG therapy might be cost effective. The findings highlight the need for further research and a randomised controlled trial (RCT) on Rewind is warranted. Practical implications: During the rewind technique, the trauma does not need to be discussed in detail, making treatment potentially more accessible for shame-based traumas. Multiple traumas may be treated in one session, making it possible for treatment to potentially be completed in fewer sessions. Social implications: This UK-based treatment may be cost effective and make treatment more accessible for people who do not want to discuss details of their trauma. Originality/value: This is the first description of HG Rewind in the peer-reviewed literature. Alternative explanations for mechanisms underlying this trauma treatment are also presented. [ABSTRACT FROM AUTHOR]

Background: Rewind is a brief trauma-focussed imaginal exposure treatment for posttraumatic stress disorder (PTSD), however evidence for this treatment is limited. Aim: The aim of this paper was to provide preliminary evidence of its efficacy in the treatment of PTSD symptoms. Method: A practice-based pre-post treatment design with an intention-to-treat analysis was used. Sixty three people were treated with Rewind in three separate services. Participants were assessed using the Impact of Events Scale (IES) prior to treatment and were re-assessed at a two-week follow-up. All participants who scored above 25 on the IES were included and there were no other exclusion criteria. Results: There was an overall data capture rate of 95%. After treatment, 55 (87%) participants were below the IES clinical cut-off and, other than three participants with missing data, all participants showed reliable improvement using the IES Reliable Change Index. Conclusion: These preliminary findings suggest that Muss’ Rewind may offer a useful treatment for PTSD symptoms. Rewind may be cost-effective, given the number of sessions that were required and the relative effectiveness of newly trained therapists in delivering the therapy. Despite methodological limitations, these results suggest that a randomised controlled trial is warranted. [ABSTRACT FROM AUTHOR]

Objectives Compassion-focused therapy ( CFT) has shown promising results for a range of clinical presentations. This study explored the therapeutic competencies required to deliver CFT and organized these into a coherent framework. Design The Delphi method was used to explore and refine competencies for delivering CFT in three rounds of data collection. Methods The first round involved interviews with 12 experts in CFT. Data were analysed using template analysis to generate a draft competency framework. The main competencies were used to create a survey for rounds two and three involving CFT experts and practitioners. Data collected from the surveys were used to refine the competencies. Results The CFT competency framework ( CFT- CF) that was produced comprised 25 main competencies within six key areas of competence. The areas were as follows: competencies in creating safeness, meta-skills, non-phase-specific skills, phase-specific skills, knowledge and understanding and use of supervision. The main competencies included several subcompetencies specifying knowledge, skills and attributes needed to demonstrate the main competence. Overall, there was consensus on 14 competencies and 20 competencies exceeded an 80% agreement level. Conclusions Some of the CFT competencies overlapped with existing therapies, whilst others were specific to CFT. The CFT- CF provides useful guidance for clinicians, supervisors and training programmes. Further research could develop the CFT- CF into a therapist rating scale in order to measure the outcome of training and to assess treatment fidelity in clinical trials. Practitioner points The compassion-focused therapy competency framework (CFT-CF) identifies therapeutic competencies that overlap with existing treatments as well as those specific to compassion-focused therapy (CFT)., The CFT-CF builds guidance for the competencies required to deliver CFT in a range of clinical settings., The CFT-CF provides guidance for those training CFT therapists., The CFT-CF could be used as a basis to develop a therapist rating scale. [ABSTRACT FROM AUTHOR]

Through an expert system, it is possible to diagnose in a fast and accurate manner symptoms of pneumonia that a pig can have, as well as the level of seriousness of the illness. This can be achieved with the aid and knowledge of a veterinarian in charge of this area. Developing an expert system to aid the decision making could treat this illness that is very common among pigs. In order to develop this application it is necessary to have certain rules or an inference engine, which allows the expert system to make decisions. The web applications have had a great impact on society. Having an expert system is like having a tool with a lot of information stored, which in the end can help the user give an accurate diagnosis and treatment of the illness, minimizing production losses. [ABSTRACT FROM AUTHOR]

Objectives This article outlines specific developments in compassion-focused therapy ( CFT) for the treatment of patients with an eating disorder. Methods The article provides a narrative review based on the existing literature and current practices of CFT for eating disorders ( CFT-E). Results The role of shame, self-criticism, self-directed hostility, and difficulties in generating and experiencing affiliative emotion in patients with an eating disorder is highlighted. The article describes how CFT-E uniquely addresses these issues and discusses the current evidence base for CFT-E. It also provides an outline of recent and potential future developments in CFT-E. Conclusions CFT-E offers a promising treatment for adult outpatients who present to specialist eating disorder services with restricting and binge/purging eating disorders. Recent developments include treatment protocols for patients who are low weight and have an eating disorder and for those presenting with obesity. Practitioner points CFT-E is a group-based treatment for adult outpatients with restricting or binge/purging eating disorders attending specialist services., CFT-E has a specific protocol and interventions to address the biological, psychological, and social challenges of recovery from an eating disorder., CFT-E specifically addresses the high levels of shame and self-criticism commonly experienced by patients with an eating disorder. [ABSTRACT FROM AUTHOR]

Objectives This article outlines specific developments in compassion-focused therapy ( CFT) for the treatment of patients with an eating disorder. Methods The article provides a narrative review based on the existing literature and current practices of CFT for eating disorders ( CFT-E). Results The role of shame, self-criticism, self-directed hostility, and difficulties in generating and experiencing affiliative emotion in patients with an eating disorder is highlighted. The article describes how CFT-E uniquely addresses these issues and discusses the current evidence base for CFT-E. It also provides an outline of recent and potential future developments in CFT-E. Conclusions CFT-E offers a promising treatment for adult outpatients who present to specialist eating disorder services with restricting and binge/purging eating disorders. Recent developments include treatment protocols for patients who are low weight and have an eating disorder and for those presenting with obesity. Practitioner points CFT-E is a group-based treatment for adult outpatients with restricting or binge/purging eating disorders attending specialist services., CFT-E has a specific protocol and interventions to address the biological, psychological, and social challenges of recovery from an eating disorder., CFT-E specifically addresses the high levels of shame and self-criticism commonly experienced by patients with an eating disorder. [ABSTRACT FROM AUTHOR]

ABSTRACT Background It has been suggested that mental health services can help meet the attachment needs of inpatients and improve patient outcomes through the provision of a 'secure base'; however, what defines the latter is unclear. Perception of ward climate might be a useful indicator. Aim The aim of this study was to examine whether inpatient perceptions of the ward climate, which is partly under the control of the service, or inpatients' own personal levels of attachment anxiety and avoidance are more associated with their attachment to their service. Method Seventy-six men diagnosed with a psychotic illness, who were residents in one of four regional medium-security units in England, completed questionnaire measures of service attachment, personal attachment style and ward climate. Results Ward climate was more strongly associated with service attachment than personal levels of attachment anxiety and avoidance. The most important aspect of ward climate for service attachment was the depth and influence of staff support for the inpatients. Conclusions Although patient characteristics are important influences on development of service attachment, ward climate is also important. The latter may be easily and reliably monitored with a brief questionnaire. Strategies to enhance and maintain its positive components are likely to be important for progress with forensic hospital inpatients who have a psychotic illness. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Evidence for the effectiveness of psychological therapies for anorexia nervosa (AN) is inconsistent. There have been no systematic reviews solely on the effectiveness for Cognitive Behavioural Therapy (CBT) for AN. This review aimed to synthesise and appraise the recent evidence for CBT as a treatment for AN. Using specific search criteria, 16 relevant articles were identified which evaluated CBT alone or as part of a broader randomised/non-randomised trial. Various formats of CBT were utilised in the reviewed papers. Studies were evaluated using established quality criteria. The evidence reviewed suggested that CBT demonstrated effectiveness as a means of improving treatment adherence and minimising dropout amongst patients with AN. While CBT appeared to demonstrate some improvements in key outcomes (body mass index, eating-disorder symptoms, broader psychopathology), it was not consistently superior to other treatments (including dietary counselling, non-specific supportive management, interpersonal therapy, behavioural family therapy). Numerous methodological limitations apply to the available evidence. Further research and ongoing review is needed to evaluate the settings, patient groups and formats in which CBT may be effective as a treatment for AN. [Copyright &y& Elsevier]

Abstract: The objectives of this review were to systematically identify and evaluate quantitative research comparing family functioning (a) in eating disorder families with control families, (b) in families with different eating disorder diagnoses (c) perceptions of different family members and (d) the relationship between family functioning and recovery. This adds to the findings of previous reviews of family functioning by including data from control families, the range of diagnoses, and focusing on recovery. Findings were considered in relation to models of family functioning. Using specific search criteria, 17 research papers were identified and evaluated. Findings indicated that eating disorder families reported worse family functioning than control families but there was little evidence for a typical pattern of family dysfunction. A consistent pattern of family dysfunction for different diagnoses was not suggested but patients consistently rated their family as more dysfunctional than one or both of their parents. With respect to outcome and recovery, those with more positive perceptions of family functioning generally had more positive outcomes, irrespective of severity of eating disorder. Conclusions were limited by inconsistent findings and methodological issues. Further research is needed into the relationship between family functioning and outcome and the assessment of family functioning beyond self-report. [Copyright &y& Elsevier]

The article focuses on shame and shame-based responses associated with eating disorders. It reviews several research correlating shame with eating disorders and the role of shame and pride in eating disorders' start and maintenance. Shame is viewed as part of the coping strategies adopted by people due to their eating disorder beliefs and behavior.

Objective Several studies have investigated shame in eating disorders but most have used non-clinical samples examined only one type of eating disorder or included only a limited range of shame measures. The current study explored shame from multiple perspectives in women who report a range of eating disorder diagnoses and who are at different stages of illness and recovery. Method In a postal questionnaire study, 224 women with a history of an eating disorder completed measures of anorexic and bulimic symptoms, depression and shame. Results After controlling for levels of depression, shame was associated with eating disorder symptoms. Specifically, shame as a measure of ‘perceived involuntary subordination’ (external shame) was uniquely associated with severity of anorexia nervosa symptoms, while shame as a measure of ‘feelings’ (internal shame) was uniquely associated with severity of bulimia nervosa symptoms. Discussion Different types of shame are related to different eating disorder symptoms and this may have implications for the aetiology and presentation of these disorders. These affective states may need to be addressed explicitly in therapy. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Animal analogues of anorexia nervosa suggest that submissive behaviour and social defeat may be implicated in the onset of wasting diseases. Data from human sufferers of anorexia nervosa and bulimia nervosa are also consistent with the presence of submissive behaviours and perceived low social rank (e.g. low self-esteem, helplessness, and feelings of shame). A total of 101 patients with eating disorders completed the Submissive Behaviour Scale and the Social Comparison Rating Scale, and their responses were compared with 101 age- and sex-matched student controls. Patients with eating disorders reported significantly higher levels of submissive behaviour and a more unfavourable social comparison than did student controls. Furthermore, levels of submissive behaviour and unfavourable social comparison were significantly related to severity of eating disorder symptoms, even after taking account of depressive symptoms and other psychopathology. These preliminary results suggest that ranking theory may have some application to eating disorders. Further research is required to determine whether rank plays a specific role in eating disorders (beyond the increased rates of depression which also occur in eating disorders) and, if so, what is its precise role. factors. However, it is possible that many of these factors are related to issues of social rank. This paper is an initial exploration of perceived rank and submissive behaviour in eating disorders. Below, we describe data from animal studies that initially prompted this interest in ranking theory. This is followed by a description of ranking theory itself and then a brief summary of results from the human literature on eating disorders that are consistent with ranking theory and which provide a rationale for examining rank related variables explicitly. [ABSTRACT FROM AUTHOR]

Compares the usefulness of the assessment instruments called Health of the Nation Outcome Scale (HoNOS) and the Social Behavior Schedule (SBS) in discriminating three groups of long-standing psychiatric patients with different levels of disability. Discrimination between patients groups; Advantages of HoNOS with regard to brevity.

Dependency associated with depression involves at least two forms of social behavior: (a) needs for nurturance/protection and close attachment, and an inability to function independently and (b) being (de)valued, fear of disapproval, and social status. In many studies, measures of dependency combine these two dimensions. This paper argues that this has led to confusion on the salient dimensions related to depression. It is suggested that behaviors currently regarded as dependent, and linked to depression, are better understood as forms of involuntary subordination that involve judgments of personal inferiority, and submissive-appeasement behavior. This paper presents preliminary evidence that social status, and its associated features of negative self-other comparisons and submissive behavior, may be particularly relevant to depression. [ABSTRACT FROM AUTHOR]

This study considers how judgements of relative social rank (inferior- superior) and shame may be related to interpersonal problems and psychopathology. Recall of parental care, overprotection, put-down/shaming and favouritism in relation to current perceptions of interpersonal problems and self-perceptions of shame and submissive behaviour were investigated. Findings suggest that perceptions of early experiences of put-down/shaming by parents and being a non- favoured child are salient variables in vulnerability to interpersonal problems and psychopathology-proneness. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To test for differences between diagnostic groups on the severity of eating disorder beliefs and behaviours, evaluate the clinical significance of such differences, and assess the extent to which these beliefs and behaviours may be present at clinically significant levels across eating disorder diagnoses. Method: 136 adult women outpatients (aged 18–65, with a BMI over 15) were diagnosed with an eating disorder and completed the Stirling Eating Disorder Scale. Results: The expected pattern of statistically significant differences was found between diagnostic groups on anorexic dietary beliefs and behaviours and bulimic dietary beliefs and behaviours. A high percentage of participants in each diagnostic group scored above the clinical cut-off on the eating disorder belief and behaviour measures and a very high percentage of participants in each group reported clinically significant levels of restricting beliefs. Conclusions: Transdiagnostic or functional analytic approaches to treatment planning may lead to more effective interventions than current, diagnostically-based, care pathways. The high prevalence of restricting beliefs reported suggested that this may need to be a key focus for intervention for the majority of individuals presenting with an eating disorder. [Copyright &y& Elsevier]

Increased prevalence and interest in male eating disorders (EDs) suggests that EDs are no longer conceptualized as a uniquely female experience. Nonetheless, rates of male help-seeking for EDs are worryingly low and empirical efforts to understand the reasons for this gender disparity have thus far been limited. This review aimed to identify and examine published literature reporting on male barriers to help-seeking for EDs, to facilitate access to timely and appropriate care. A systematic literature search identified eight papers meeting eligibility criteria. Narrative synthesis was used to integrate the elicited mixed-methods data and several higher order themes (individual, socio-environmental, organizational, contextual factors) and lower order themes (e.g., internalized stigma and shame, delayed social recognition, feminized services and information) were generated. Barriers to help-seeking included a variety of internal and external factors, operating across socioecological systems. Gender-specific barriers related to the wider cultural context and influence of normative constructions of masculinity. Despite overlap with female ED literature, men do appear to encounter (and require targeted support to overcome) unique challenges in accessing quality healthcare for EDs. Recommendations for the design of clinical interventions and future research are outlined. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about the use of the diagnosis related groups (DRG) system by the U.S. Department of Veterans Affairs hospitals in the December 29, issue.

Background People suffering from an eating disorder ( ED), or more generally with eating, body image, and weight concerns, have been found to experience high levels of self-criticism, self-directed hostility, and shame. Furthermore, these individuals tend to have difficulties generating and activating affiliative and self-soothing emotions. Methods Compassion focused therapy ( CFT) specifically addresses these issues, and CFT for eating disorders ( CFT-E) was designed to incorporate the development and practice of compassion for self and others into standard ED treatment programs to assist with these issues. Results This article describes (1) the theoretical rationale for cultivating compassion for self and others as part of ED treatment, (2) the adaptation and incorporation of CFT-E within ED treatment programs, and (3) a qualitative review of the current evidence base for CFT-E. Conclusions Finally, the article will explore recent and potential future developments in CFT-E, and recommendations for the use of CFT-E in clinical practice, including its application for those who present with other eating and weight concerns (such as being overweight or obese), and various modes of inpatient and community-based delivery. [ABSTRACT FROM AUTHOR]