Search

Background: Disorganized attachment has been identified as an important factor in the development and maintenance of mental health problems. Further research is required to understand the mechanism by which this attachment pattern predisposes individuals to develop, and maintain, personal and social difficulties and mental health problems utilizing valid and reliable measurement tools. The assessment of adult disorganized attachment is therefore important for both applied psychologists and researchers. Method: We conducted a systematic review using the COSMIN guidelines to identify and critically appraise instruments which measure adult disorganized attachment. A systematic database search was performed using MEDLINE, EMBASE, Web of Science, PsychInfo and CINHAL in accordance with PRISMA guidelines. Results: Database searching provided 5757 results, with 18 measures identified across 27 eligible papers which were critically evaluated. Measurement properties were promising for the Childhood Disorganization and Role Reversal Scale, Psychological Treatment Inventory‐Attachment Styles Scale, Attachment Style Questionnaire ‐ Short Form and the Adult Attachment Interview. However, overall, due to inconsistent quality of methodology and reporting of results, it is challenging to reach sufficient conclusions and suggestions regarding the best instrument to use to measure adult disorganized attachment. Conclusion: The Childhood Disorganization and Role Reversal Scale, Psychological Treatment Inventory‐Attachment Styles Scale. Attachment Style Questionnaire‐Short‐Form and Adult Attachment Interview are the best available measures of disorganized attachment in adulthood. This review highlights the need for further psychometric testing of existing measures, or development of new instruments, grounded in sound methodology. [ABSTRACT FROM AUTHOR]

This paper sought to provide the first validation of a transdiagnostic measure of repetitive negative thinking – the Perseverative Thinking Questionnaire‐Child version (PTQ‐C) – in young people diagnosed with anxiety and depressive disorders. Participants (N = 114) were 11‐ to 17‐year‐olds with complex and comorbid presentations seeking treatment through Child and Adolescent Mental Health Services. Confirmatory factor analyses best supported a three‐factor model for the PTQ‐C; however, hypotheses of both perfect and close fit were rejected, and a subsequent bifactor model suggested minimal unique variance for each subscale. Results demonstrated good internal consistency, convergent validity and divergent validity for the total score and three PTQ‐S subscales: core characteristics, perceived unproductiveness, and consumed mental capacity of negative repetitive thinking. PTQ‐C scores did not account for additional variance in anxiety symptoms once worry was considered, indicating that retention of a content‐specific measure may be warranted in clinical samples. Findings emphasize the importance of validating clinically relevant measures which were developed with subclinical populations in samples with diagnosed mental health disorders. Practitioner points: Validates Perseverative Thinking Questionnaire in anxious and depressed youth.Support for convergent and divergent validity, and internal consistency.Results suggest measure is appropriate for complex and comorbid presentations. [ABSTRACT FROM AUTHOR]

Objectives: This paper outlines best practice recommendations for the clinical psychologist's role in inpatient settings and also presents a methodology for deriving evidence‐based recommendations, which may be replicated by health care professionals in other areas of service development. Methods: Twenty‐three, nationally drawn experts, deemed expert by profession and/or experience attended a one‐day conference. Participants were presented with findings from previous research and key unanswered questions in terms of how psychological services should be delivered in inpatient settings. Participants discussed the information presented within small groups and then independently responded to the questions posed. Responses to questions either involved ranking priorities or choosing the best possible option in terms of what or how aspects of the model should be delivered. Results: We were able to identify referral priorities for formulation, nurse‐led psychosocial interventions and psychological therapy using ranking questions. Consensus (defined as 70% agreement) was achieved within 1–3 voting rounds for all questions which involved selecting one of a range of possible options. These responses provided information about how to deliver formulation, supervision of nurse‐led psychosocial interventions, staff well‐being interventions, and one‐to‐one therapy, as well as psychologists' own training and supervisions needs. Conclusions: Findings provide recommendations relating to five different service areas for inpatient settings seeking to implement a psychological service model: formulation, nurse‐led interventions, one‐to‐one therapy, staff well‐being, and psychologist training and supervision. Additionally, we showcase a methodology for synthesizing knowledge and decision‐making that can be implemented by researchers and health care professionals seeking to design interventions or service models in other settings. Practitioner points: Psychologists working on inpatient wards should endeavour to develop a team formulation for each patient, prioritizing patients with longer length of stay, repeated admissions, and who staff find challenging.Psychologists should offer 1:1 therapy with patients who have complex needs that cannot be addressed by nurse‐led interventions.Reflective practice sessions should be a key component of the psychologist's role on inpatient wards with the function of improving staff well‐being.Consensus conferences are useful methodology to synthesize knowledge and undertaking decision‐making in relation to the design of interventions or service models. [ABSTRACT FROM AUTHOR]

Objectives: Severe life events are established as provoking agents for depression in combination with vulnerability factors. Identifying features of severe events improves the prediction of disorder but are rarely utilized, mainly because life event research is increasingly dominated by self‐report checklists with no capacity for inferring such characteristics. This paper investigates the association of severe life events' features with depression and insecure attachment styles using a new online measure of life events in a clinical and control sample. Methods: A total of 202 participants (75 clinical and 127 matched control participants), taken from an earlier national Depression Case Control genetic study and followed up after 12 years, completed the Computerised Life Events Assessment Record to assess characteristics of life events, the Vulnerable Attachment Style Questionnaire to measure attachment insecurity, and the General Health Questionnaire to measure depression. Results: The clinical group had higher self‐reported depression, severe life events, and insecure attachment style. They also reported more loss, danger, humiliation, and trauma severe events. Intra‐respondent analysis showed individuals experiencing these types of events were more likely to report depression. Insecure attachment style and severe life events were both significantly related to recent depression and history of depressive disorder. Anxious attachment style was significantly related to relationship events and bereavements, as well as severe loss or humiliation events, whereas avoidant style was not. Conclusions: Identifying salient features of severe life events improves associations with depression and insecure attachment style. Utilizing a new online approach can aid research and clinical approaches for depression at low cost. Practitioner points: Salient features of severe life events (e.g., loss, humiliation) give insight into the potential impact on attachment vulnerability and depression.Clinicians and researchers can use online methods to economically gain detailed life event information needed for clinical formulation and valid data on stressors.The self‐reported scale for recent depression is only a proxy measure of clinical disorder, but the clinical group selection is a more robust criterion for depression history. [ABSTRACT FROM AUTHOR]

Objective The importance of coping style factors in the process of emotional adjustment following acquired brain injury ( ABI) has been gaining increased attention. To assess ways of coping with distress accurately, clear conceptual definitions and measurement precision is vital. The purpose of this study was to investigate the psychometric properties of a well-known measure of coping, the Coping Inventory for Stressful Situations ( CISS), for people who have experienced an ABI; and to modify the CISS, where necessary, to create a more reliable and valid measurement tool for this clinical group. Methods Psychometric properties were investigated using Rasch analysis of responses from a sample of adults with ABI ( n = 207). The internal consistency reliability and construct validity of the scale were examined. Results All originally proposed subscales were not valid or reliable and, as such, were incapable of interval-level measurement within this sample - Task: χ2(32, N = 207) = 105.1, p < .001; Emotion: χ2(32, N = 204) = 121.9, p < .001; Avoidance: χ2(32, N = 207) = 66.7, p < .001. Three valid and reliable subscales were derived measuring emotion-, task-, and avoidance-oriented coping styles by removing items that provided the most unreliable information and exploring fit to the Rasch model. Conclusions The original version of the CISS may not be a valid and reliable measure of coping style following ABI. Modified subscales of the three distinct coping domains have been proposed that would help to improve measurement of coping style following ABI in future research and clinical practice. Practitioner points How people cope with difficulties following an ABI has been shown to impact upon emotional outcomes and functional recovery., The original version of the CISS was found to be an imprecise measure of coping following ABI., A modified version of the CISS was found to be a valid and reliable measure of three styles of coping (task-focused, emotion-focused, and avoidance-focused) that conforms to the properties of interval-level measurement as represented by the Rasch model. This structure is in keeping with previous theoretical models of coping., We advise caution about including items (1, 6, 7, 22, 24, 28, 29, 33, 34, and 46) that were found to diverge from the expectations of the Rasch measurement model in total subscale scores for measuring change in coping style., A conversion table for the three modified subscales is included in this paper to convert total raw scores into Rasch transformed logit values., Identifying strengths and weaknesses in coping style could be a means of guiding psychological intervention to promote good recovery following ABI., The sample included mainly people who had experienced non-traumatic brain injuries (e.g., a stroke)., This research could be extended to include broader sample of people with differing brain injury aetiologies and neurological disorders. [ABSTRACT FROM AUTHOR]

Objectives. Dissatisfaction with services has been associated with poorer child mental health outcomes, early treatment termination as well as disagreements over the nature of mental health difficulties, reasons for referral and therapy goals. The development of straightforward, reliable, and accurate methods of eliciting service users' views is essential within child and adolescent mental health care. This paper describes the development of the child and adolescent service experience (ChASE), a tool to measure children and young people's service experience Design. The study comprises a non-experimental, cross-sectional design. Methods. Participants were 132 mental health service users aged 8-18 years. Participants and their main carer completed the ChASE, Parent Satisfaction Questionnaire (PSQ) () and Strengths and Difficulties (SDQ) Impact Supplement. Clinicians completed the SDQ Impact Supplement and provided clinical activity data. A sub-sample of participants completed the ChASE on a second occasion, 6 weeks after the completion of the first questionnaire. Results. Scrutiny of ChASE data indicated high levels of completion. Principal axis factoring identified three factors within the ChASE: Relationship, Privacy, and Session Activity. The ChASE has good internal consistency and test-retest reliability. Significant correlations were found between the ChASE and carer satisfaction, service use, and youth clinical outcomes. Conclusions. The ChASE is a short, psychometrically robust tool for routine measurement of children, and young people's experience of mental health services, which users can complete easily. The results underline the importance of alliance factors to children and young people and their association with clinical improvement as well as the potential for the ChASE to be used a measure of children's therapeutic progress and alliance. [ABSTRACT FROM AUTHOR]

Objectives: Assess (a) the variability of behaviour problems in children with Hyperkinetic Disorder/Attention‐DeficitHyperactivity Disorder (HKD/ADHD) across a range of family situations and (b) the degree to which behaviour in each situation can be modified through a cognitive behavioural parent training (CBPT). Furthermore (c), compare the effectiveness of training in two different formats and (d) test the proposition that group treatment benefits behaviour in a wider range of situations than individual treatment. Method: A registered multicentre randomized controlled trial comparing individual and group parent training to treatment‐as‐usual (TAU) for N = 237 children with HKD/ADHD. A German version of the Home Situations Questionnaire (HSQ) was employed to examine behaviour problems across a range of family situations, treatment‐related changes post‐treatment and at 6‐month follow‐up, while controlling for medication status. Results: Parents reported considerable variance in severity of behaviour problems across situations. All groups improved with time, but individual and group CBPT led to significantly greater improvement than TAU in many family situations. Results present situation‐specific treatment trajectories and demonstrate somewhat greater impact of individual compared with group training in certain situations post‐training and 6 months later. Conclusions: CBPT clearly adds to TAU (with effect sizes in the small to moderate range depending on situation). Individual was somewhat more successful than group format (which did not succeed in a wider range of situations). HSQ situations reveal a differentiated picture of child behaviour and treatment results. Situation‐specific assessment with an instrument like the HSQ offers promising perspectives that invite further development. [ABSTRACT FROM AUTHOR]

Objectives: High rates of probable post‐traumatic stress disorder (PTSD) and major depressive disorder (MDD) have been reported for frontline healthcare staff during the COVID‐19 pandemic. However, rates determined by diagnostic assessment are unknown, as are the onset of symptoms and associated index events. Methods: We assessed frontline healthcare staff with the Structured Clinical Interview for DSM‐5. Results: Forty‐four percent met criteria for PTSD and 39% met criteria for MDD. Twenty‐four percent reported COVID‐19 trauma as their index event, with the majority of staff reporting trauma that pre‐dated the pandemic. While PTSD was likely to be pre‐existing, MDD was more likely to develop during pandemic working. Conclusion: These findings indicate the propensity of healthcare staff to experience a range of occupational and personal trauma associated with PTSD and the need to assess index trauma when diagnosing psychopathology in order to best understand the needs of this workforce. Practitioner points: We found high diagnostic rates of PTSD (44%) and major depression (39%) among frontline healthcare staff working during the COVID‐19 pandemic.Although major depression developed during the pandemic, PTSD was more likely to be pre‐existing.When assessing pandemic‐related psychopathology, it is important to assess the onset and index event related to symptoms.Healthcare workers appear to have high rates of PTSD related to occupational and personal trauma, which warrants specific focus in service planning. [ABSTRACT FROM AUTHOR]

Objectives: Bouldering has shown promising results in the treatment of various health problems. In previous research, bouldering psychotherapy (BPT) was shown to be superior to a waitlist control group and to physical exercise with regard to reducing symptoms of depression. The primary aim of this study was to compare group BPT with group cognitive behavioural psychotherapy (CBT) to test the hypothesis that BPT would be equally as effective as CBT. Design: We conducted a randomized, controlled, assessor‐blinded non‐inferiority trial in which 156 outpatients meeting the criteria of a depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) were randomly assigned to one of the two intervention groups (CBT: N = 77, BPT: N = 79). Methods: Intervention groups were manualized and treated for 10 weeks with a maximum of 11 participants and two therapists. The primary outcome was depressive symptom severity assessed with the Montgomery–Åsberg Depression Rating Scale (MADRS) and the Patient Health questionnaire (PHQ‐9) at the beginning and end of the treatment phase as well as one year after the end of treatment. Result: In both groups, depressive symptoms improved significantly by an average of one severity level, moving from moderate to mild depressive symptoms after therapy (MADRS difference scores: BPT −8.06, 95% CI [−10.85, −5.27], p <.001; CBT −5.99, 95% CI [−8.55, −3.44], p <.001). The non‐inferiority of BPT in comparison with CBT was established on the basis of the lower bound of the 95% confidence interval falling above all of the predefined margins. BPT was found to be effective in both the short (d = 0.89) and long term (d = 1.15). Conclusion: Group BPT was found to be equally as effective as group CBT. Positive effects were maintained until at least 12 months after the end of therapy. Thus, BPT is a promising approach for broadening the therapeutic field of therapies for depression. Practitioner points: Physical activity is effective in the treatment of depression and current guidelines explicitly recommend it as a complementary method for the treatment of depression. Nevertheless, body‐related interventions are still underrepresented in current treatments for depression.Bouldering psychotherapy (BPT) combines physical activity with psychotherapeutic content. Its concept relies on proven effective factors from CBT such as exposure training, problem solving and practicing new functional behaviours and is thus an enrichment and implementation of CBT methods on the bouldering wall.The positive effect of group bouldering psychotherapy (BPT) in reducing depressive symptoms in outpatients with depression is not inferior to the effect of group cognitive behavioural therapy (CBT).Additionally the 10‐weeks BPT‐programme significantly improved symptoms of anxiety and interpersonal sensitivity as well as health‐related quality of life, coping, body image, self‐efficacy, and global self‐esteem. [ABSTRACT FROM AUTHOR]

Objectives: To investigate associations between alcohol use, psychological treatment attendance, and clinical outcomes. Methods: We analysed electronic health records for N = 7,986 patients accessing psychological treatment for common mental disorders. Data were collected for pre‐treatment alcohol use (average units per week) and severity of dependence (SDS), number of therapy contacts attended, pre‐ and post‐treatment anxiety (GAD‐7), and depression (PHQ‐9) symptom severity. Hierarchical regression was used to examine associations between alcohol use/dependence and post‐treatment symptom severity controlling for intake severity and relevant confounders. Results: After controlling for confounders, alcohol use had significant nonlinear associations with pre‐treatment depression severity (R2 =.54, p <.01, cubic trend), and post‐treatment anxiety (R2 =.23, p <.01, quadratic trend). Alcohol use was not significantly associated with intake anxiety, post‐treatment depression or treatment duration. SDS was not significantly associated with depression severity, alcohol severity, or total contacts after controlling for confounders. Conclusion: Alcohol users are just as likely to engage in and benefit from evidence‐based psychological treatments for depression in primary care. A nonlinear association between alcohol use and anxiety treatment outcomes indicates that light‐to‐moderate drinkers have some shared characteristic that favours treatment response. Practitioner points: Depression and anxiety problems often co‐occur with alcohol use and dependence.Conventional wisdom in the field suggests that heavy alcohol users may not engage well or benefit from psychological therapies for depression and anxiety.We found no empirical support for the above assumptions in a large clinical sample.Alcohol consumption was not significantly associated with treatment attendance or depression treatment outcomes.A nonlinear association between alcohol use and anxiety outcomes suggests that moderate drinkers may have some shared characteristic that favours treatment response. [ABSTRACT FROM AUTHOR]

Objective: Paranoia is known to vary with levels of coalitional threat and safety present in the social environment. However, it remains underexplored whether threat and safety are differentially associated with paranoia, if these relationships vary with the source of threat and safety, and whether such effects hold across the continuum of severity of paranoid thoughts. Methods: We employed a network analysis approach with community analysis on a large dataset (n = 6,337), the UK Adult Psychiatric Morbidity Survey 2007, to explore these questions. We included one node to capture paranoia typical in the general population, and one pertaining to thought interference common in persecutory delusions in psychosis. Results: Nodes reflecting paranoia in the general population as well as persecution‐related concerns in psychosis shared the strongest positive edges with nodes representing threat stemming from close social relationships. Paranoia common in the general population was negatively associated with both safety stemming from the wider social environment, and safety in close relationships, where the former association was strongest. Conclusions: Our results suggest that threat from within one's immediate social group is more closely linked to paranoid thoughts than is safety from either one's social group or the wider social environment. Further, our results imply that coalitional threat may be a particularly associated with concerns common in psychosis, whereas paranoid ideation more common in the general population is also associated with reduced coalitional safety. Overall, this network analysis offers a broad view of how paranoia relates to multiple aspects of our coalitional environment and provides some testable predictions for future research in this area. Practitioner points: Individuals with paranoia more typical of delusions may find threat in close social relationships most challengingVariation in paranoia in the general population may be attributed to feeling safe in the wider social environment more than in close social relationships [ABSTRACT FROM AUTHOR]

Objectives: Mental contamination (MC) describes subjective internal feelings of 'dirtiness', which are experienced in the absence of direct physical contact/contaminants. There is evidence of a link between MC in obsessive compulsive disorder (OCD) and the experience of past betrayals. However, it has also been noted that 'perpetrators' also experience MC. We aimed to replicate the previous finding of specificity of OCD for sensitivity to being betrayed by comparing with those suffering from depression, and to extend this by evaluating whether people with high MC OCD are also relatively more sensitive to the idea that they might betray others compared to those with low levels of MC OCD. Design: A cross‐sectional, between‐groups design was used. Method: Four groups, high MC OCD (N = 60), low MC OCD (N = 61), depression (N = 28), and non‐clinical controls (N = 46) completed online questionnaires. Participants were recruited through the National Health Service (NHS) and social media. Results: Relative to all groups, the high MC OCD group had significantly higher scores both for betrayal sensitivity and sensitivity to betraying others. The depression group showed similar levels to low MC OCD in betrayal sensitivity but were significantly lower (and comparable to non‐clinical controls) in sensitivity to betraying others. Conclusions: Betrayal sensitivity occurs trans‐diagnostically. There may be a specific link between the development of OCD and the perception of betraying others, perhaps linked to the trauma of being betrayed making those so affected more likely to worry about their own responsibility for betraying others. Practitioner points: Clinicians should, across diagnoses, attend to sensitivity to being betrayed and the experiences which may have led to this.Current treatments for MC OCD recommend working with historical experiences of 'betrayal'. This study suggests that people with OCD also have an increased sensitivity to the idea of being a 'perpetrator' of betrayal linked to high responsibility beliefs.Specifically for OCD, it is possible that the experience of previously being betrayed results in increased current sensitivity to being responsible for being a 'betrayer'. It may, therefore, also be useful for therapists to consider if patients with MC OCD are concerned about potentially betraying others and to consider this within the formulation.The focus of clinical work could be to redefine these difficulties by reappraising beliefs regarding experience of betrayal and the likelihood of betraying others.Elevated levels of betrayal sensitivity were found in people with depression, and this may need to be considered in treatment approaches. [ABSTRACT FROM AUTHOR]

Objectives: Adolescence is a time period which confers significant risk for the development of psychopathology. There is increasing consensus within the literature that beliefs about one's emotional experience are important and may present a unique risk factor during this time period. However, to date, there has been no longitudinal examination of the relationship between depression and specific beliefs regarding the acceptability of experiencing and expressing emotion in young people. Design: The present study used a cross‐lagged longitudinal design with questionnaires completed at two waves spaced 8 months apart. Methods: 506 participants (50.60% female) aged 12–15 years completed the Beliefs about Emotion questionnaire to assess for beliefs regarding the acceptability of experiencing and expressing emotions, and the depression subscale of the DASS‐21 to measure depressive symptoms. Results: Greater depressive symptoms were associated with more negative beliefs about emotion at both time points. More negative beliefs about emotion at T1 did not significantly predict greater depressive symptoms at T2. However, greater depressive symptoms at T1 predicted significantly more negative beliefs about emotions at T2. Conclusions: Greater beliefs about the unacceptability of experiencing or expressing emotions do not appear to predispose young people to depression. Rather, these beliefs appear to emerge following earlier experiences of depressive symptoms. Further research is needed over multiple measurement waves to further elucidate the relationship between emotion acceptance beliefs and depressive symptoms across adolescence into adulthood and whether such beliefs may predict future depressive episodes indirectly via difficulties in emotion regulation. Practitioner points: Current findings suggest that more negative beliefs about emotion, specifically, beliefs about the unacceptability of experiencing or expressing emotions do not represent a key risk factor for the onset of depressive symptoms in early adolescence. Rather, current evidence suggests these beliefs emerge following depressive symptoms.Given these findings, universal prevention programmes targeting valuation beliefs regarding emotion acceptability are less likely to be effective for this developmental age group.It is important to assess for beliefs that an individual may hold regarding their emotional states alongside symptoms, as these beliefs are associated with greater clinical severity of depressive symptoms.Further research, over multiple measurement waves, is needed to clarify whether emotion acceptability beliefs may predict future depressive episodes indirectly via difficulties in emotion regulation. [ABSTRACT FROM AUTHOR]

Objectives: Childhood psychotic‐like experiences (PLEs) increase risk for concurrent and future psychiatric disorders but are common in the population. Strategies are needed to identify vulnerable individuals who may benefit from monitoring or targeted intervention. This study aimed to delineate profiles of childhood PLEs that might be differentially associated with other psychopathologies, and multiple psychopathology. Design: Cross‐sectional, online self‐report survey. Methods: Participants were 27,000 Australian children from a population cohort (13,416 girls; mean age 11.91 years) who completed an online self‐report questionnaire assessing PLEs (hallucinations and delusions) and Emotional, Peer Relationship, Conduct, and Hyperactivity–Inattention psychopathology. Latent class analysis differentiated classes of children showing different patterns of PLE responses, and multinomial logistic regression determined the association between the PLE classes and the various psychopathologies, adjusted for demographic covariates and the other psychopathologies. Results: Five latent profiles of PLE responses were characterized as follows: None (27.4% of children), Minor (29.7%), Moderate (11.8%), Hallucinatory (21.0%), and Strong (10.2%). These classes showed distinct associations with other psychopathologies (odds ratios between 1.27 and 4.58), and dose–response relationships indicated increasing likelihood of multiple psychopathology for the Hallucinatory and Strong classes (odds ratio = 21.87 for ≥3 psychopathologies in the Strong class). Conclusions: Tailored interventions that address the particular needs of these different classes of individuals may be warranted. Practitioner points: Children aged 11–12 years who report psychotic‐like experiences (PLEs) can be classified into five different PLE profiles based on self‐reported questionnaire responses, which may reflect different pathological processes.These PLE profiles show different patterns and magnitudes of increased risk for other types of psychopathology, and multiple psychopathology, suggesting that they present different treatment needs.Cross‐sectional investigation of the associations between PLE profiles and other psychopathologies limits any conclusions as to the causal direction of these relationships.Multi‐informant reports of psychopathology were unavailable. [ABSTRACT FROM AUTHOR]

Objectives: Acute psychiatric inpatient wards are characterized by minimal provision of therapeutic activities and high readmission rates. Implementation of a comprehensive inpatient psychological intervention service has been recommended to overcome these problems; however, whether this is feasible or effective remains unclear. Methods: This non‐randomized parallel cluster feasibility trial examined the feasibility of delivering and evaluating cross‐diagnostic psychologically informed acute psychiatric care the Edinburgh‐Acute Psychological Inpatient Therapy Service (EDAPTS) and gathered preliminary clinical outcome data. Patients able to consent and complete questionnaires were recruited from two adult acute wards (i.e., clusters) and received either EDAPTS plus TAU or TAU. Results: Between October 2015 and October 2016, 96 inpatients were recruited. Findings suggested that there were good data completion rates for several clinical outcomes, that several EDAPTS components were successfully delivered, and that some initial effects appeared to favour the intervention, depending on outcome. However, difficulties relating to the recruitment process were also identified, as well as problems relating to adequate delivery of group therapies, participant engagement in some intervention components, and data completion at follow‐up. Conclusion: These issues, and the feasibility of randomization and rater‐blinding, have important implications for the design of future trials. Overall, this study provides an important insight into the challenges and complexities of developing and evaluating a comprehensive psychological intervention service in an acute psychiatric setting. Practitioner points: Individual therapy sessions can be delivered in the acute environment.The EDAPTS intervention showed some promise on outcomes of distress and self‐efficacy.Delivery of nurse‐led groups was challenging and may need to be embedded into routine clinical practice to increase intervention and outcome reach.More parameters, for example, randomization at cluster level, should be tested before progressing to an adequately powered, single‐blind, definitive cluster RCT. [ABSTRACT FROM AUTHOR]

Objective: To examine the psychometric properties of the Emotion Regulation Questionnaire (ERQ) among a sample of older community‐dwelling males and females and to also assess gender differences in the association between emotion regulation and positive and negative affect. Method: The ERQ and the Positive and Negative Affect Schedule‐10 were administered to 252 older adults (age range 60–89 years; 48.4% female). Results: The two ERQ subscales, reappraisal and suppression, were internally consistent. Reappraisal was positively correlated with positive affect among both genders, and negatively correlated with negative affect among older women only. Suppression was positively correlated with negative affect among older men only and unrelated to positive affect for both genders. Confirmatory factor analysis showed that a two‐factor solution fits the data from both genders. Conclusion: The results provide evidence to support the ERQ for use with older adults, while identifying clinically important gender differences in the associations between emotion regulation tendencies and affect in older age. Practitioner points: Reliability and validity of the 10‐item Emotion Regulation Questionnaire is supported for use among older adults.Suppression positively correlated with negative affect among older men but not older women.Reappraisal negatively correlated with negative affect among older women but not men.The current data from a community‐dwelling population may not generalize to older adults with clinical disorders. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of neurocognitive functioning on the self‐focused processing styles of rumination and reflection, and the relationship to mood symptoms after severe traumatic brain injury (TBI). Design: A cross‐sectional design with a between‐group component comparing self‐focused processing styles and mood symptoms of adults with TBI and age‐ and gender‐matched controls. Method: Fifty‐two participants with severe TBI (75% male, M age = 36.56, SD = 12.39) completed cognitive tests of attention, memory, executive functioning and the Awareness Questionnaire, Reflection and Rumination Questionnaire (RRQ), and Depression, Anxiety, and Stress Scales (DASS – 21). Fifty age‐ and gender‐matched controls completed the RRQ and DASS‐21. Results: TBI participants reported significantly greater mood symptoms than controls (p < .05); however, levels of rumination and reflection did not significantly differ. TBI participants high on both reflection and rumination had significantly greater mood symptoms than those with high reflection and low rumination (p < .001). Higher levels of rumination and reflection were associated with better working memory and immediate and delayed verbal memory (r = .36–.43, p < .01). Higher levels of rumination were also associated with greater verbal fluency, self‐awareness, and mood symptoms (r = .36–.70, p < .01). Conclusions: Individuals with better memory functioning may be more likely to engage in self‐focused processing after severe TBI. Reflection without ruminative tendencies is more adaptive for mental health than reflection with rumination. Practitioner points: Individuals with severe TBI report more mood symptoms than non‐injured controls but do not differ on self‐focused processing.Poorer memory function is related to lower levels of rumination and reflection.Reflection without ruminative tendencies is adaptive for mental health after severe TBI.Individuals with greater self‐awareness and ruminative tendencies are at increased risk of mental health problems following severe TBI. Limitations: Rumination and reflection were assessed using a self‐report measure which assumes that people with severe TBI are able to reliably report on self‐focused processing styles.The direction of associations between self‐focused processing, self‐awareness, and mood symptoms could not be determined due to the cross‐sectional design. [ABSTRACT FROM AUTHOR]

Objectives: Depression is characterized by a range of systematic negative biases in thinking and information processing. These biases are believed to play a causal role in the aetiology and maintenance of depression, and it has been proposed that the combined effect of cognitive biases may have greater impact on depression than individual biases alone. Yet little is known about how these biases interact during adolescence when onset is most common. Methods: In this study, adolescents were recruited from the community (n = 212) and from a Child And Adolescent Mental Health Service (n = 84). Participants completed measures of depressive symptoms, interpretation bias, self‐evaluation, and recall memory. These included the Mood and Feelings Questionnaire, Ambiguous Scenarios Test for Depression in Adolescents, Self‐Description Questionnaire, and an immediate recall task. The clinically referred sample also took part in a formal diagnostic interview. Results: Individual cognitive biases were significantly intercorrelated and associated with depression severity. The combination of cognitive biases was a stronger predictor of depression severity than individual biases alone, predicting 60% of the variance in depression severity across all participants. There were two significant predictors, interpretation bias and negative self‐evaluation; however, almost all of the variance was explained by negative self‐evaluation. Conclusions: The findings support the interrelationship and additive effect of biases in explaining depression and suggest that understanding the way in which cognitive biases interact could be important in advancing methods of identification, early intervention, and treatment. Practitioner points: A combination of biases was a better predictor of depression symptom severity than individual biases. Interpretation and self‐evaluation were better predictors of depression symptom severity than recall. Negative self‐evaluation was the strongest individual predictor of depression symptom severity. Negative self‐evaluation was able to classify depressed from non‐depressed adolescents. The cross‐sectional design of the study precludes any conclusions about the potential causal role of these variables. Different tasks were used to assess different types of cognitive bias meaning that the possible linear operation along an information processing ‘pathway’ could not be examined. [ABSTRACT FROM AUTHOR]

Objectives: Low positive emotionality (PE) represents a temperamental vulnerability to depression in youth. Until now, little research has examined the mechanisms linking PE to depressive symptoms. Starting from integrated cognitive‐affective models of depression, we aimed to study adaptive emotion regulation (ER) as a key underlying mechanism in the temperament–depression relationship. Methods: This study investigated whether adaptive ER strategies mediate the association between PE and depressive symptoms in a large community‐based sample of youth, using a cross‐sectional design. Participants were 1,655 youth (54% girls; 7–16 years, M = 11.41, SD = 1.88) who filled out a set of questionnaires assessing temperament, adaptive ER strategies, and depressive symptoms. Results: Results revealed that low PE was significantly related to higher depressive symptoms among youth and that a lack of total adaptive ER abilities mediated this relationship. More specifically, the infrequent use of problem‐solving appeared to be of significant importance. Problems in positive refocusing and a deficient use of forgetting mediated the relationships between low PE and high negative emotionality (NE) in predicting depressive symptoms. Reappraisal and distraction were not significant mediators. Conclusion: Results highlight the need to account for temperamental PE and adaptive ER strategies when studying youth depression. The findings contribute to a more nuanced understanding on the differential role of temperamental risk factors for developing depressive symptoms at an early stage and advocate for greater attention to adaptive ER strategies. Practitioner points: Clinical interventions for youth depression may be improved by incorporating adaptive emotion regulation (ER) strategies and enhancing positive emotions. Youth low in positive emotionality (PE) may especially benefit from learning adaptive ER skills. Clinical practitioners should focus on alleviating negative emotions and enhancing positive emotions, especially among youth low in PE. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to investigate the link between social group identification and mental health outcomes in a sample of secondary school pupils. Based on previous work, it was predicted that multiple high group identifications would protect against psychological ill health. Furthermore, it was predicted that better mental health would also predict greater number of group identifications, thus creating a 'virtuous circle'. Design A longitudinal questionnaire design was used. Methods A total of 409 Scottish secondary school pupils aged 13-17 completed a questionnaire twice over a year. Pupils' responses regarding their mental health and the extent of their identification with three groups (the family, school, and friends) were measured. Results A path analysis of the data showed that greater number of high group identifications predicted better mental health outcomes amongst participants. However, better mental health also predicted greater number of high group identifications, suggesting that there is a cyclical relationship between both variables. Conclusions The findings have both theoretical and practical implications. They highlight the importance of conceptualizing the link between group identification and mental health as cyclical, rather than unidirectional. This reconceptualization has implications for mental health promotion strategies, as it highlights the importance of attempting to turn a potentially 'vicious cycle' of social disidentification and mental ill health into a 'virtuous cycle' of social identification and mental health. Practitioner points Results showed that in a population of 409 high school pupils, the more high group identifications pupils had, the better their mental health outcomes., Better mental health also predicted a greater number of high group identifications over time., The findings suggest that we would benefit from conceptualizing the relationship between group identification and mental outcomes as being cyclical rather than unidirectional., Viewing the relationship between group identification and mental health in this way enables us to consider interventions which help turn a 'vicious cycle' into a 'virtuous cycle'., Limitations A potential limitation of the work relates to the use of self-report questionnaires which may elicit socially desirable responses., The sample only consists of high school pupils from mainstream public schools within Scotland. [ABSTRACT FROM AUTHOR]

Objectives This study examined parental perceptions of behaviours that challenge ( CB) in their adult children with intellectual disability (ID), and explored whether perceptions mediated associations between CB and parental psychological distress. Design A within-group correlational design was employed. Methods Sixty-five parents reported on individuals with genetic syndromes and ID who had chronic CB. Parents completed the Illness Perception Questionnaire-Revised ( IPQ-R) adapted to measure perceptions of self-injury, aggression or property destruction, alongside assessments of parental locus of control, attributions about behaviour, parental psychological distress, and CB. Results A high proportion of parents evidenced anxiety and depression at clinically significant levels (56.9% and 30.8%, respectively). Contrary to predictions, psychological distress was not significantly associated with CB. The perception that the adult with ID exerted control over the parent's life mediated the association between CB and parental psychological distress. Few parents endorsed operant reinforcement as a cause of CB (< 10%). Conclusions The high levels of psychological distress in parents is notable and of concern. Further research should consider the reasons why parents have causal attributions that might be inconsistent with contemporary interventions. Practitioner points Parents experience high levels of psychological distress while supporting adults with ID who engage in chronic behaviours that challenge., A stronger belief that the adult with ID exerts control over the parent's life may mediate an association between CB exhibited by the individual with ID and parental psychological distress., Few parents endorsed operant reinforcement as a cause of behaviours that challenge. [ABSTRACT FROM AUTHOR]

Objectives Trans-diagnostic approaches suggest that key cognitive and behavioural processes maintain symptoms across a wide range of mental health disorders. Fatigue is a common clinical feature of attention deficit hyperactivity disorder ( ADHD) in adulthood; however, empirical data supporting its prevalence are lacking. This study aimed to collate outcomes from outpatient services to (1) investigate the prevalence of fatigue in adults with ADHD, (2) examine symptoms of ADHD in adults with chronic fatigue syndrome ( CFS), and (3) consider secondary clinical characteristics common to both disorder groups. Methods Measures of self-reported fatigue were compared across groups of adults with ADHD ( N = 243), CFS ( N = 86), and healthy controls (HC) ( N = 211) using a between-subjects cross-sectional design. Groups were also compared on secondary clinical measures of functional impairment, mood, anxiety, sleep, self-efficacy, and their beliefs about the acceptability of expressing emotions. Results The ADHD group were significantly more fatigued than HC with 62% meeting criteria for fatigue caseness. ADHD symptoms were significantly greater in the CFS group than in HC. ADHD and CFS groups did not differ significantly on measures of functional impairment, mood, and self-efficacy. No significant differences were detected on measures of anxiety when items relating to physical restlessness were removed from the analysis. Conclusions Adults with ADHD experience greater fatigue than HC. Adults with CFS and ADHD share many trans-diagnostic clinical characteristics, including difficulties with low mood, anxiety, and reduced self-efficacy, which impact upon their overall functioning. Further research is required to investigate extraneous factors mediating fatigue severity in these clinical groups. Practitioner points Fatigue is a common clinical feature of attention deficit hyperactivity disorder (ADHD) in adulthood., Evidence-based interventions for chronic fatigue syndrome could be adapted to address fatigue in ADHD in adults. [ABSTRACT FROM AUTHOR]

Objectives Mental ill-health has become a large health problem and it is important for caregivers to provide effective treatment alternatives. REGASSA is a randomized controlled study performed in primary care to study the effects of 12 weeks of Internet-based cognitive behaviour therapy ( ICBT) and physical exercise ( PE) compared with treatment as usual ( TAU) in patients with mild-to-moderate mental ill-health. The present study aimed to examine the results of these treatment alternatives on psychological functioning, stress, and sleep disturbances. Methods The study comprised 879 patients with mental ill-health taking part in the REGASSA study. Data were collected by Interactive Voice Response ( IVR), a computerized, automated telephone technique. The treatments were compared at baseline, twice during treatment, at the end of treatment and at three follow-ups after treatment. Measures used were the Outcome Questionnaire-45, the short versions of the Perceived Stress Scale, and the Karolinska Sleep Questionnaire. Results Linear mixed models showed that the patients in ICBT and PE had better results than in TAU on psychological functioning and sleep disturbances, p < .001 , with weak-to-moderate effect sizes. On stress there were no differences; all groups made improvements. Women had stronger effects than men. More patients recovered on psychological functioning ( OQ-45) in ICBT and PE than in TAU. Conclusions Internet-based cognitive behaviour therapy and PE proved to be effective treatment alternatives for patients with mild-to-moderate mental ill-health in improving psychological functioning, stress, and sleep disturbances and could be useful alternatives in primary care. Practitioner points Internet-based cognitive behaviour therapy and physical exercise proved to be effective treatment alternatives for mental ill-health patients in primary care., Automated techniques (Interactive Voice Response) could be useful for following treatment course in large groups of patients in the health care., It is important to use measures that capture different aspects of patients' health problems., The recruitment of participants was based on patients' interest and inclusion criteria which may have affect the generalizability. [ABSTRACT FROM AUTHOR]

Objective The ongoing Social Cognition Psychometric Evaluation (SCOPE) study is in the process of forming a gold-standard battery of social cognition tests for use in clinical trials. Previous SCOPE phases have not acknowledged key differences between social cognition skills and biases, and psychometric validity analyses might provide important information if tailored to bias-related outcomes. This study aims to validate these measures with such bias-related outcomes. Methods Two measures of social cognitive bias - the Ambiguous Intention Hostility Questionnaire (AIHQ; hostile attribution bias) and Trustworthiness Task (distrust bias) - were reviewed according to their relationships to (1) current and prospective symptom levels, (2) questionnaires of trait paranoia and hostility and informant-rated hostility, (3) interpersonal conflict, as well as (4) relationships to measures of trait paranoia, hostility, and interpersonal conflict above and beyond the influence of clinically rated symptoms. Results Results supported hypotheses that social cognitive bias provides information about cognition, symptoms, and functioning related to interpersonal conflict. Each bias demonstrated relationships to trait paranoia questionnaires, hostility, or interpersonal conflict outcomes, and these persisted above and beyond the influence of clinically rated symptoms. Hostile attribution bias also predicted change in symptom levels over a brief interval. Conclusions Overall, the current bias-specific psychometric analysis provides support for continued study of social cognitive biases. Practitioner points Hostile attribution bias may play a role in important outcome variables given relationships to emotional discomfort and suspiciousness symptoms, trait paranoia and hostility, interpersonal conflict, as well as prospective hostility symptoms., Distrust bias may also impact real-world functioning, as it is related to hostility, suspiciousness, and positive symptoms, trait paranoia, and hostility., Relationships of social cognitive biases to interpersonal conflict outcomes exist independently of interview-rated symptoms and persist above and beyond the influence of social cognitive skills, which appear to demonstrate weaker relationships to these outcomes., Understanding and assessing the individual's biases towards distrust or blame might help practioners predict interpersonal conflict and future increases in symptoms. [ABSTRACT FROM AUTHOR]

Objectives Diagnosis is ubiquitous in Psychiatry, and whilst it does bring benefits; adverse effects of 'labelling' may also be possible. This study aimed to evaluate experimentally whether clinicians' judgements about a patient with panic disorder were influenced by an inappropriately suggested diagnosis of comorbid borderline personality disorder ( BPD). Design An experimental design was used to evaluate clinician's judgements when the nature of the information they were given was varied to imply BPD comorbidity. Methods Two hundred and sixty-five clinicians watched a video-recorded assessment of a woman describing her experience of uncomplicated 'panic disorder' and then rated her present problems and likely prognosis. Prior to watching the video recording, participants were randomly allocated to one of three conditions with written information including the following: (1) her personal details and general background; (2) the addition of a behavioural description consistent with BPD; and (3) the further addition of a 'label' (past BPD diagnosis). Results The BPD label was associated with more negative ratings of the woman's problems and her prognosis than both information alone and a behavioural description of BPD 'symptoms'. Conclusions Regardless of potential actuarial value of such diagnoses, it is concluded that clinicians can be overly influenced by past diagnostic labels in the context of an apparent current comorbid problem, although such biases appear to be less likely if a description of the relevant behaviours is used instead. Thus, the label, rather than the behaviour it denotes, may be stigmatizing in mental health professionals. Practitioner points Diagnostic labels can have an inappropriately negative effect on clinicians' judgements not only of treatment variables such as engagement and response but also risk issues and interpersonal effectiveness., Diagnostic labels can have a greater effect on clinicians' judgements than a behavioural description or clinical presentation., Clinicians should therefore be cautious both in the use of diagnostic labels to describe patients and ensure that these are still valid, and also be mindful of the influence that such labels can have on their own clinical judgements and constantly seek to challenge these., Behavioural descriptions of difficulties are less likely to result in such negative judgements and predictions. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to investigate the social validity of cognitive-behavioural parent training ( CBPT) delivered in two formats to parents who have children with hyperkinetic disorder ( HKD) with and without medication. Design Compared individual with group treatment as part of a multicentre randomized controlled trial. Method Obtained a broad range of evaluations and satisfaction ratings post-treatment and related them to pre-treatment and treatment factors. Results Attendance rates were high in the individual and slightly less in the group training. Levels of satisfaction were high in both treatment arms with large numbers rating the outcomes, the trainers and the overall training very favourably. Medication showed no effect on parental evaluations. Evaluation of outcomes and satisfaction with the trainer emerged as strong predictors of overall programme satisfaction. Conclusion The social validity of cognitive-behavioural parent training for hyperkinetic children was supported by high levels of treatment acceptability across a range of indicators and for children with and without medication. Practitioner points Both forms of treatment delivery lead to high rates of consumer satisfaction., Consumer evaluations of CBPT appear independent of medication for HKD., Course satisfaction is clearly associated with two factors that trainers can affect: The parent-trainer relationship and parents' sense of achievement., Limitations include the following Far more mothers than fathers attended the trainings., Attitudes may differ in other cultures. [ABSTRACT FROM AUTHOR]

Objectives Research has suggested that the extent to which voices (i.e., auditory verbal hallucinations) are experienced as distressing might be influenced by negative beliefs about voices as well as maladaptive metacognitive styles involving the negative appraisal and maladaptive control of mental experiences. This cross-sectional study examined the contribution of both specific appraisals of voices and a metacognitive factor (i.e., experiential avoidance) to voice-related distress. Methods Self-report measurers of voice characteristics (voice frequency, duration as well as amount and intensity of voice-related distress), experiential avoidance, and appraisals of voices were collected in a sample of 101 voice-hearers. Results Experiential avoidance and negative beliefs about voices were associated with higher levels of voice-related distress, but not to measures of voice frequency and duration. Experiential avoidance and negative 'metaphysical' beliefs about voices were significant predictors of voice-related distress even after accounting for the effect of frequency and duration of voices, and explained similar proportions of unique variance in distress. Conclusions These findings suggest that the appraisals of voices and experiential avoidance are predictive of voice-related distress and that cognitive-behavioural interventions targeting both voice-specific appraisals and general maladaptive metacognitive processes could prove useful treatment approaches for clients with distressing voices. Practitioner points Experiential avoidance ( EA) and negative appraisals predict voice-related distress caused by voices, but not their frequency and duration., Interventions for voices should consider targeting EA and negative appraisals (e.g., cognitive-behavioural therapy, Acceptance and Commitment Therapy) to ameliorate distress. [ABSTRACT FROM AUTHOR]

Objectives To examine the impact of memory accessibility on episodic future thinking. Design Single-case study of neurological patient HCM and an age-matched comparison group of neurologically Healthy Controls. Methods We administered a full battery of tests assessing general intelligence, memory, and executive functioning. To assess autobiographical memory, the Autobiographical Memory Interview ( Kopelman, Wilson, & Baddeley, 1990. The Autobiographical Memory Interview. Bury St. Edmunds, UK: Thames Valley Test Company) was administered. The Past Episodic and Future Episodic sections of Dalla Barba's Confabulation Battery ( Dalla Barba, 1993, Cogn. Neuropsychol., 1, 1) and a specifically tailored Mental Time Travel Questionnaire were administered to assess future thinking in HCM and age-matched controls. Results HCM presented with a deficit in forming new memories (anterograde amnesia) and recalling events from before the onset of neurological impairment (retrograde amnesia). HCM's autobiographical memory impairments are characterized by a paucity of memories from Recent Life. In comparison with controls, two features of his future thoughts are apparent: Reduced episodic future thinking and outdated content of his episodic future thoughts. Conclusions This article suggests neuropsychologists should look beyond popular conceptualizations of the past-future relation in amnesia via focussing on reduced future thinking. Investigating both the quantity and quality of future thoughts produced by amnesic patients may lead to developments in understanding the complex nature of future thinking disorders resulting from memory impairments. Practitioner points We highlight the clinical importance of examining the content of future thoughts in amnesic patients, rather than only its quantitative reduction., We propose an explanation of how quantitative and qualitative aspects of future thinking could be affected by amnesia. This could provide a useful approach to understand clinical cases of impaired prospection., Limitations Systematic group investigations are required to fully examine our hypothesis., Although the current study utilized typical future thinking measures, these may be limited and we highlight the need to develop clinically relevant measures of prospection. [ABSTRACT FROM AUTHOR]

Objectives Negative beliefs about psychosis and other mental health difficulties may contribute to depression and distress in individuals with these experiences. The Personal Beliefs about Experience Questionnaire ( PBEQ) and Personal Beliefs about Illness Questionnaire ( PBIllQ) are two widely used measures of these beliefs. It is currently uncertain how the items on these measures map onto different underlying factors. This study therefore aimed to test the factor structure of these two measures. Methods Confirmatory factor analysis ( CFA) was used to test three alternative, pre-specified, factor structures for the PBIllQ and PBEQ in a sample of individuals diagnosed with bipolar disorder ( n = 202) and a sample of individuals with experien-ces of psychosis ( n = 362). Associations with depressive symptoms were also examined. Result A three-factor structure was supported for both measures, which included Negative Expectations/Appraisals ( NEA), Internal Shame/Defectiveness ( ISD) and External Shame ( ES) factors. The NEA and ISD subscales also had consistent independent associations with depressive symptoms. Conclusions The results suggest that the PBIllQ and PBEQ may capture three distinct sets of negative beliefs in individuals with psychosis or bipolar disorder and that these beliefs may have important consequences for subsequent difficulties in these populations such as depression. Both measures may be helpful in supporting assessment and formulation in clinical practice and in evaluating belief change in intervention trials. However, when used in these settings, the three subscales identified in this study may be the most valid way of calculating scores on these measures. Practitioner points Negative personal beliefs about the causes, meaning and consequences of psychosis and bipolar disorder are associated with greater distress and depression. Two related measures, the PBIllQ and PBEQ, have been developed to assess these beliefs., Our analyses suggest that scores on these questionnaires are best broken down into three subscales which capture perceptions of internal shame or defectiveness, general negative appraisals and perceptions of external shame., These subscales may capture key underlying sets of negative beliefs within individuals with psychosis or bipolar disorder, which in turn impact upon well-being, such as being associated with greater depression., These subscales can be used to aid assessment and formulation within clinical practice but may also provide a valuable means of assessing changes in negative beliefs following interventions. [ABSTRACT FROM AUTHOR]

Objectives In order to assist mental health services in developing countries, a key issue is the availability of psychometrically sound, brief, and cost-effective measures that have been tested within the relevant context. The present study was designed to evaluate within a young Bangladeshi population, the psychometric properties of two widely used Western measures of internalizing distress in young people: the short form of the Spence Children's Anxiety Scale and the Short Moods and Feelings Questionnaire. Method The sample included 1,360 children and adolescents aged 9-17 years ( M = 12.3 years, SD = 2.12) recruited from six districts of Bangladesh, including both community and emotionally at-risk participants. A total of 179 children were re-tested on the measures within 3-4 weeks. Results Confirmatory factor analyses showed single-factor structures for both scales in the total sample and in both community and at-risk participants separately. Multiple group analyses across gender and age-group within the at-risk and community samples showed that the single-factor structure was suitable regardless of subgroup. Analyses also indicated acceptable internal consistency, test-retest reliability and construct validity for both scales. Conclusion The two measures show promise as brief, reliable, and valid instruments for the assessment of internalizing distress among young people from Bangla-speaking communities. Practitioner points Positive clinical implications These two measures of internalizing distress in young people showed solid psychometric properties within samples collected from various parts of Bangladesh. The measures can therefore be used to assess anxiety and depression in Bangla-speaking youth., These measures should be of value in both clinical settings and at a community level to assess the need for services., Cautions and limitations Resource limitations did not allow comparison against diagnostic criteria and therefore cut-off scores to indicate clinical status among Bangladeshi youth will require further research. [ABSTRACT FROM AUTHOR]

Objectives Rumination is a risk factor after bereavement, predicting higher concurrent and prospective symptom levels of complicated grief and depression in mourners. Research has shown that rumination may consist of adaptive and maladaptive subtypes, but there has been a paucity of research in this topic in the bereavement area. Therefore, we aimed to clarify whether functional and dysfunctional forms of rumination can be distinguished after loss. Design Two-hundred and forty-two adults, who lost a first-degree family member on average 10 months previously, filled out questionnaires at three time points with 6 months between each time point. Methods Multiple regression analyses, controlled for loss-related variables, neuroticism, and baseline symptoms, were run to examine associations of subtypes of depressive rumination (brooding, reflection) and grief rumination (rumination about injustice, meaning, reactions, relationships and counterfactual thinking) with concurrent and prospective symptom levels of complicated grief and depression. Results Overall, grief rumination explained more variance in symptom levels than depressive rumination. Other major findings were that grief rumination about injustice predicted higher concurrent and prospective symptom levels of complicated grief and higher prospective symptom levels of depression. In contrast, grief rumination about emotional reactions was related to prospective reductions in symptoms of complicated grief. Reflection was also associated with prospective reductions of complicated grief and depressive symptom levels. Conclusions Results indicate that adaptive and maladaptive forms of ruminative thinking can be distinguished in bereaved individuals. Therapeutic interventions for complicated grief could potentially be improved by including techniques aimed at reducing maladaptive rumination and increasing adaptive rumination. Practitioner points Clinical implications Adaptive and maladaptive components of rumination after loss can be distinguished. They are differentially associated with concurrent and prospective symptom levels of complicated grief and depression in mourners., Adaptive rumination after bereavement is characterized by repetitive, self-focused thinking aimed at understanding one's depressive and loss-related emotional reactions., Maladaptive rumination is characterized by repetitive, self-focused thinking about injustice to the self and making passive comparisons between the current situation (in which one has experienced a loss) and unrealized alternatives., Psychological interventions for complicated grief may be improved by adding therapeutic techniques aimed at reducing maladaptive rumination and increasing adaptive rumination., Cautions and limitations This investigation relied exclusively on self-report measures., Conjugally bereaved women were overrepresented in the current sample., Complicated grief and depression levels in the current sample ranged from non-clinical to clinical. Effects may be more pronounced in a clinical sample. [ABSTRACT FROM AUTHOR]

Objectives In daily life, many decisions of minor and major importance have to be made. Thereby, intuitive judgments serve as useful guides and help us to adapt to our environment. People with major depressive disorder ( MDD) often have difficulties to come to decisions. Is their intuition impaired? Since this question has not been addressed until now, the present study explored intuition in MDD. Methods Depressed patients ( n = 29) and healthy control participants ( n = 27) completed the Judgment of Semantic Coherence Task, a well-established paradigm used in basic cognitive research to measure intuition. Furthermore, participants' severity of depressive symptoms ( BDI- II), negative affect (PANAS), and rumination (RSQ) were assessed. All participants were interviewed with the SCID. Results Depressed patients showed impaired intuition compared to healthy control participants. In the depressed sample, negative affect accounts for the association between rumination and impaired intuition. Results further reveal that negative affect overall mediates the depression-intuition relationship. Patients with diminished ability to concentrate or indecisiveness had lower intuition indices compared to patients who did not fulfil this diagnostic criterion of MDD. Conclusions The study introduces the phenomenon of intuition into depression research. Additionally, these results extent findings from basic research showing that induced negative mood as well difficulties to down-regulate negative affect impair intuitive coherence judgments. Current results indicate that the negative affectivity of patients is the crucial mediator in the association between depression and impaired intuition. Limitations of the study as well as the potential etiological role of intuition in MDD are discussed. Practitioner points The finding that intuition is impaired in depressed patients extends our knowledge as to the cognitive profile of patients with MDD., Patients who suffer from indecisiveness have lower intuition indices compared to patients who do not fulfill this diagnostic criterion of MDD., Due to the cross-sectional design, final conclusions as to the etiological role of intuition in MDD cannot be drawn., The question remains open whether impaired intuition is specific to MDD. [ABSTRACT FROM AUTHOR]

Objectives Evidence suggests that obsessive-compulsive disorder ( OCD) is characterized by heightened self-reported disgust, however, it is unclear if this extends to physiology. The relationship between obsessive beliefs and disgust also remains poorly understood. Therefore, we examined whether the heightened trait and self-reported disgust observed in individuals with OCD is reflected in heightened physiological disgust responses. We also examined whether obsessive beliefs are associated with disgust responding. Design A 3 (group) × 6 (stimulus) repeated measures design was used to examine disgust responses in individuals with OCD to six categories of image stimuli: body waste, contamination, injury, sociomoral, neutral, negative non-disgust. Methods Individuals with OCD ( n = 25) were compared to individuals with non- OCD anxiety disorders ( n = 21) and healthy participants ( n = 25) with respect to trait, self-reported, facial electromyographic and electrodermal disgust responses. Results Individuals with OCD showed greater disgust propensity and self-reported disgust to images of body waste compared to healthy and anxious participants, however, there were no group differences in physiological responses. After controlling for trait disgust, obsessive beliefs positively correlated with increased self-reported disgust to neutral images and increased levator labii activity to negative non-disgusting images. Conclusions Although individuals with OCD showed elevated disgust propensity and self-reported ratings of body waste stimuli, there was little evidence that OCD is characterized by an abnormal physiological disgust response. The intensity of obsessive beliefs was associated with a tendency to respond with disgust in contexts that are non-disgusting, indicating that obsessive beliefs may be implicated in pathological disgust. Practitioner points Individuals with OCD display greater levels of disgust propensity and self-reported disgust to images of body waste compared to healthy control participants and individuals with non- OCD anxiety disorders., The abnormalities in self-reported disgust observed in those with OCD do not extend to abnormalities in electrodermal activity or facial electromyographic responses., Maladaptive obsessive beliefs commonly associated with OCD predict heightened disgust in contexts where objective sources of disgust are absent, even after controlling for trait disgust., Maladaptive obsessive beliefs may therefore be implicated in pathological disgust., This study used a heterogeneous OCD sample and future research is needed to determine whether the observed effects are greater for those with primarily washing and contamination symptoms., Although group differences emerged in self-reported disgust, further replications using measures of state anxiety are needed to rule out the possibility that heightened self-reported disgust was confounded with co-occurring fear or general negative affect. [ABSTRACT FROM AUTHOR]

Objective This study aimed to identify baseline predictors of autonomous and controlled motivation for treatment ( ACMT) in a transdiagnostic eating disorder sample, and to examine whether ACMT at baseline predicted change in eating disorder psychopathology during treatment. Method Participants were 97 individuals who met DSM- IV- TR criteria for an eating disorder and were admitted to a specialized intensive treatment programme. Self-report measures of eating disorder psychopathology, ACMT, and various psychosocial variables were completed at the start of treatment. A subset of these measures was completed again after 3, 6, 9, and 12 weeks of treatment. Results Multiple regression analyses showed that baseline autonomous motivation was higher among patients who reported more self-compassion and more received social support, whereas the only baseline predictor of controlled motivation was shame. Multilevel modelling revealed that higher baseline autonomous motivation predicted faster decreases in global eating disorder psychopathology, whereas the level of controlled motivation at baseline did not. Conclusion The current findings suggest that developing interventions designed to foster autonomous motivation specifically and employing autonomy supportive strategies may be important to improving eating disorders treatment outcome. Practitioner points The findings of this study suggest that developing motivational interventions that focus specifically on enhancing autonomous motivation for change may be important for promoting eating disorder recovery., Our results lend support for the use of autonomy supportive strategies to strengthen personally meaningful reasons to achieve freely chosen change goals in order to enhance treatment for eating disorders., One study limitation is that there were no follow-up assessments beyond the 12-week study and we therefore do not know whether the relationships that we observed persisted after treatment., Another limitation is that this was a correlational study and it is therefore important to be cautious about making causal conclusions when interpreting the results. [ABSTRACT FROM AUTHOR]

Objectives Treatment failure is a common phenomenon, but little is known about the reasons. Therapeutic alliance, therapist adherence, and therapist competence are considered important aspects of treatment success and formed the focus of the current investigation. Design Three randomized controlled trials for the treatment of depression, social phobia, and hypochondriasis were the basis of the current study. Methods The role of therapeutic alliance, as well as therapist adherence and competence, were investigated in 61 patients, which were classified either as treatment failure or as treatment success. Process variables were evaluated by independent raters on the basis of videotapes of the first three treatment sessions. Results Therapists' adherence and therapeutic alliance differed significantly between successful treatments and those classified as failures, whereas therapists' competence did not. In cross-sectional analysis, we found a moderating effect of adherence with alliance on treatment outcome, indicating that the better the therapeutic alliance, the stronger the effect of adherence on treatment outcome. Moreover, higher therapists' competence was found to affect treatment outcome positively, only mediated by therapeutic alliance. Higher therapists' adherence affected treatment outcome positively, only mediated by the competence-alliance relationship. In additional longitudinal analyses, we found evidence that the therapeutic alliance within one session influences therapists' adherence and competence in the subsequent session, but not the other way around. Conclusions Therapeutic alliance proved to be an important variable for the prediction of treatment failure. Furthermore, in our longitudinal analyses, we found evidence that the therapeutic alliance is a precondition for the adherent and competent implementation of therapeutic techniques, which questions the results of our cross-sectional analysis and of previous research. Practitioner points Clinical implications Treatment failure is associated with a lower therapeutic alliance in cognitive-behavioural treatment., Therapeutic alliance seems to be an important precondition for the adherent and competent implementation of therapeutic techniques., Therapeutic alliance should be monitored during psychotherapeutic treatment., Cautions or limitations Results are limited to cognitive-behavioural therapy and may not be representative for other treatment approaches., Process analyses are based on highly standardized randomized controlled trials and may not be generalizable to routine care. [ABSTRACT FROM AUTHOR]

Objectives This prospective study investigated whether within-individual relations between depression vulnerability factors (childhood trauma, dysfunctional attitudes, maladaptive coping) and depressive symptom trajectories varied as a function of the number of prior major depressive episodes (MDEs) experienced in their lifetime. Design Participants were 68 young adults who varied with regard to their history of depression; 32 were remitted depressed and 36 were never depressed. Methods Depressive symptoms and disorders were assessed using semi-structured psychiatric interviews conducted twice over a 6-month period; interviews yielded weekly ratings of depressive symptoms during the follow-up interval. Childhood trauma, dysfunctional attitudes and coping were assessed with self-report measures. Data analyses were conducted using time-lagged multilevel models. Results Individuals with more previous MDEs who reported greater childhood trauma exposure, more dysfunctional attitudes, or greater use of maladaptive coping strategies experienced more rapid increases in depressive symptoms during the follow-up period. A significant interaction of coping, number of previous MDEs, and time was found indicating that among individuals with less adaptive coping (i.e., lower primary or lower secondary control coping scores), depressive symptoms rating ( DSR) increased significantly in relation to number of prior depressive episodes; no change in DSR was observed for never-depressed individuals. Among individuals with higher primary control coping scores, significant increases in DSR scores were observed for individuals with ≥3 prior MDEs only. Conclusions Findings highlight the need for treatment and prevention programmes that target stress reactivity and coping strategies early in the course of depression. Practitioner points Findings highlight the need to conduct multi-dimensional assessments of depression vulnerability that examine the interplay among risk factors over time., Relations between vulnerability factors (childhood trauma, dysfunctional attitudes, maladaptive coping) and depressive symptoms were stronger for individuals with more prior major depressive episodes (MDEs)., Interventions for recurrent depression should focus on secondary control coping strategies that emphasize accommodation to stressful life events., Future studies should assess high-risk individuals before their first MDE to determine whether vulnerability factors linked with recurrence are pre-existing and relatively stable, or if they reflect 'scars' from MDEs. [ABSTRACT FROM AUTHOR]

Objective This study examined how the personality traits of self-criticism and dependency moderated the effects of situational interpersonal cues on fear during interpersonal interactions among individuals with social anxiety disorder ( SAD). We hypothesized that self-criticism would moderate the fear-inducing effects of situational self-consciousness and that dependency would moderate the fear-inducing effects of situational emotional insecurity. Methods Forty SAD patients ( Mage = 29.23) and matched community controls ( Mage = 28.93) completed event-contingent record forms after each significant social interaction of over 5 min for a 20-day period. There were 20 female patients and 20 male patients in each group. Results Event-level self-consciousness was more strongly associated with elevations in fear among socially anxious patients who reported higher levels of self-criticism, while event-level emotional security was more strongly associated with decreases in fear among SAD patients who reported higher levels of dependency. These interactions were not found in the community sample. Conclusions Findings support the application of personality-vulnerability models to understanding fear during social interactions in patients with SAD. Results also have implications for psychotherapeutic treatments of SAD. Practitioner points Although social anxiety disorder (SAD) patients are on average more self-critical and dependent than community participants, some SAD patients are particularly self-critical, while others are particularly dependent., Highly self-critical SAD patients are more likely to feel fear during interpersonal situations when they feel self-conscious., Highly dependent SAD patients are more likely to feel fear during interpersonal interactions when they feel less emotionally secure., SAD patients were compared to a community sample, so we do not know if group differences are due to the presence of SAD or psychopathology in general. [ABSTRACT FROM AUTHOR]

Objective To examine the factor structure of the self-report Strengths and Difficulties Questionnaire ( SDQ) for data from a sample of British children aged 6-10 years. Method The self-report SDQ was administered to 900 children aged 6-10 years via interviews with trained counsellors. Results Confirmatory and exploratory factor analyses showed that a two-factor solution comprising 'externalizing and peer problems' and 'internalizing problems' fit the data well for both the 6- to 7- and 8- to 10-year-old samples. The factors were correlated in both samples. Conclusions Children between 6 and 10 years of age provided meaningful SDQ data. The identified two-factor model maps broadly onto the constructs of externalizing and internalizing behaviour. Practitioner points The findings suggest that children in the United Kingdom younger than 11 years of age are able to complete the Strengths and Difficulties Questionnaire (SDQ), providing practitioners with a picture of a child's insight and understanding of their problems., The findings show that, with children aged 6-10 years, the self-report SDQ provides information about two factors that map broadly onto the constructs of externalizing and internalizing behaviour., This study is the first in the United Kingdom to examine the self-report SDQ in young children, adding weight to an emerging literature base., To support understanding in very young children, the self-report SDQ should to be delivered via interview, so that self-descriptions are appropriate to the child's developmental level. [ABSTRACT FROM AUTHOR]

Objectives Cognitive behavioural therapy ( CBT) is an effective treatment for depression, but many clients do not complete therapy. What clients find difficult about CBT is poorly understood. This study explored clients' views and experiences of face-to-face CBT. Design A mixed methods design was used to collect data as part of the CoBalT trial. Method Participants randomized to CBT indicated their reasons for never starting or stopping therapy on the follow-up questionnaires. In-depth qualitative interviews took place with a purposive sample ( n = 26) of those randomized to CBT. Framework analysis was used to analyse across the data. Results Seventy-four participants withdrew from therapy or were discharged for non-adherence. A total of 54 (73%) gave reasons for not starting or stopping CBT; mostly the time/location was inconvenient or they had other commitments. Interviews identified that clients could struggle in, and between, CBT sessions. This was true for those who did and did not complete therapy. CBT homework was the biggest challenge and was often associated with negative school homework experiences. Although clients may have disliked aspects of CBT, those who attended more than one session felt that they had gained insight into managing their depression. Conclusion Highlighting the possible barriers to adherence in CBT can help clinicians to better prepare clients in making an informed choice about therapy. Exploring these issues during therapy may also help with engagement. Despite the challenges, clients can still benefit from CBT by learning strategies that enable them to effectively deal with their depression. Practitioner points Talking to participants about the challenges of CBT - such as homework - can help clinicians better prepare clients in making an informed choice about therapy., Exploration of possible barriers during therapy may also help with engagement and completion of therapy., Despite the challenges, clients report benefiting from CBT; in particular learning strategies which help identify negative thought patterns and enable them to deal more effectively with their depression. [ABSTRACT FROM AUTHOR]

Objectives The UK's Improving Access to Psychological Therapies ( IAPT) programme uses the Patient Health Questionnaire Depression Scale ( PHQ-9; Kroenke, Spitzer, & Williams, , J. Gen. Intern. Med., 16, 606) and Generalized Anxiety Disorder Scale ( GAD-7; Spitzer et al., , Arch. Intern. Med., 166, 1092) to assess patients' symptoms of depression and anxiety respectively. Data are typically collected via telephone or face-to-face; however, no study has statistically investigated whether the questionnaires' items operate equivalently across these modes of data collection. This study aimed to address this omission. Methods & Results Questionnaire data from patients registered with an IAPT service in London ( N = 23,672) were examined. Confirmatory factor analyses suggested that unidimensional factor structures adequately matched observed face-to-face and telephone data for the PHQ-9 and GAD-7. Invariance analyses revealed that while the PHQ-9 had equivalent factor loadings and latent means across data collection methods, the GAD-7 had equivalent factor loadings but unequal latent means. In support of the scales' convergent validity, positive associations between scores on the PHQ-9 and GAD-7 emerged. Conclusions With the exception of the GAD-7's latent means, the questionnaires' factor loadings and latent means were equivalent. This suggests that clinicians may meaningfully compare PHQ-9 data collected face-to-face and by telephone; however, such comparisons with the GAD-7 should be done with caution. Practitioner points The PHQ-9 and GAD-7's factor loadings were equivalent across data collection methods., Only the PHQ-9's latent means were equivalent across data collection methods., Clinicians may be confident collecting PHQ-9 data by telephone and face-to-face and, then, comparing such data., Caution is recommended when determining clinical effectiveness using telephone and face-to-face GAD-7 data., More psychometric research is warranted. [ABSTRACT FROM AUTHOR]

Objective Embedded in attachment theory is its association with affect regulation, which provides a framework for affective dysregulation in the emerging psychosis. Method Fifty-one participants meeting criteria for ultra-high risk ( UHR) of developing psychosis were recruited from a youth mental health service within the United Kingdom. At intake baseline, prior to starting therapeutic intervention, all clients were assessed on measures of affective dysregulation and attachment. Results A large proportion of our sample ( N = 51) reported clinically significant levels of depression (78%), state anxiety (59%), and social anxiety (65%). Eighty per cent of the UHR sample was insecurely attached. Insecure attachment was significantly associated with elevated depression and social anxiety. Attachment styles were associated with anxiety, depression, and social anxiety. There was no support for a mediating role of social anxiety between attachment styles and depression. Conclusion Clinically significant levels of distress and anxiety experienced by the young people at high risk of psychosis. Clinical implications for the treatment of affective dysregulation in young people at UHR in relation to their attachment styles have been discussed. Practitioner points The treatment of affective dysregulation has implications on social integration, crucial to the recovery of young people in the emerging psychosis., Assessment of adult attachment difficulties may bring to the forefront specific negative internal working models (and interpersonal schemas) which may indicate vulnerability to social anxiety and depression., Young adults at ultra-high risk of psychosis with emotional difficulties may be better at help seeking and therefore over-represented in this sample., Cross-sectional data analysis makes it difficult to draw aetiological links between adult attachment and affective dysregulation. [ABSTRACT FROM AUTHOR]

Objectives Parental appraisals of an adolescent may have an effect upon the adolescent's well-being and likelihood of emotional problems. However, the impact of these parental appraisals is likely to be partly determined by the young person's self-appraisal. It was predicted that a discrepancy in self- and parent appraisals of positive, prosocial qualities would be associated with an increased risk of emotional problems. Design The study employed a cross-sectional design within a large sample of adolescent and caregiver dyads ( N = 3,976, aged 11-17 years), drawn from the 'Mental health of children and young people in Great Britain, 2004' survey. Method Two separate measures of prosociality were used to ensure that effects were not specific to one measure. The analysis explored the discrepancy in parent and self-ratings on these measures via interactions within a logistic regression framework. Potential confounds, including gender, parental mental health, conduct and hyperkinetic problems were controlled for in the analysis. Results The logistic regression analyses demonstrated significant interactions between self- and parent ratings of prosocial qualities in predicting the odds of emotional disorder (i.e., depression and anxiety). This effect occurred across both measures of prosocial qualities whilst controlling for confounds. The pattern of the interactions suggested that low parental appraisals had a more detrimental effect on well-being when self-appraisals were highly positive. Conclusions The results suggest that moderately high self-appraised positive traits may carry a cost of leaving young people more vulnerable to discrepant, negative parental appraisals. This has important implications for the meaning attributed to self-appraised positive traits in clinical contexts. Practitioner points Clinicians should be aware that the association between parental perceptions of a child's prosociality and emotional disorder may be influenced by the adolescents' self-perceptions., Clinicians should therefore endeavour to assess both parental and adolescent appraisals., Discrepancies may be clinically meaningful, in terms of the risk of emotional problems, rather than simply being a nuisance., This study is cross-sectional, so although discrepancies may be linked to risk of emotional problems, the direction of this effect requires elucidation., The current study only focusses on the parent-adolescent dynamic and so may not extend to discrepancy effects in other areas of positive functioning or in other relational contexts. [ABSTRACT FROM AUTHOR]

Objectives This study explored specific and differential effects of metacognitive beliefs on proneness to both hallucinations and delusions in a general population sample, including a control for the alternate symptom. The study then examined whether similar findings were reproduced in a sample of people with psychotic disorders. Design Linear and hierarchical regressions were used to determine the role of metacognitive beliefs in the proneness to symptoms, whilst ANCOVAs analysed group differences. Methods Participants were recruited to a non-clinical sample ( N = 133) and a psychosis sample ( N = 100). Both groups completed the Launay-Slade Hallucinations Scale-Revised (Laroi et al., ; Eur. Psychiatry, 19, 15), the Peters Delusions Inventory (Peters et al., ; Schizophr. Bull., 25, 553), and the Metacognitions Questionnaire-30 (Wells & Cartwright-Hatton, ; Behav. Res. Ther., 42, 385). Results Metacognitions were predictive of both hallucination- and delusion-proneness in the non-clinical sample. Controlled analyses in the non-clinical sample revealed specific effects: low cognitive confidence ( CC) predicted hallucination-proneness, whilst negative beliefs about the uncontrollability and danger of thoughts ( NBUD) predicted delusion-proneness. Mean ratings on NBUD , low CC, and need to control thoughts were elevated in the psychosis sample; however, after controlling for comorbid symptoms, no metacognitive belief predicted symptom-specific vulnerability in the clinical sample. Conclusions The pattern of findings provided little support for Morrison's theoretical model of symptom-proneness. Metacognitive beliefs may be related to sub-acute vulnerability to psychosis symptoms; however, the specificity of the relationship between individual metacognitive beliefs and positive psychosis symptoms appeared no longer significant in psychosis patients. The possibility that these metacognitive beliefs are evoked by psychotic experiences, rather than primarily functioning as a driver of them, warrants greater attention. Practitioner points Clinical Implications Metacognitive beliefs appear at least equally associated with delusion-proneness as hallucination-proneness., Negative metacognitive beliefs appear more central to delusion-proneness than hallucination-proneness in the general population., When controlling for alternate symptom, no individual metacognitive belief appears reliably able to predict symptom-proneness in psychosis patients., Limitations Consistent with existing literature on metacognitions in psychosis, this study adopted a cross-sectional design, meaning we were unable to determine the causal direction of the observed associations between metacognitive beliefs and symptom-proneness., Although a strength of this study design was its control for alternate psychotic symptoms, we did not control for non-psychotic symptoms, particularly, anxiety and depression., The symptom measures used were developed primarily for assessment of psychosis-proneness within the general population; thus, their use by people with established psychosis may have been less sensitive to clinical manifestations of these phenomena. [ABSTRACT FROM AUTHOR]

Objective To develop a valid and reliable measure of the supervisory relationship ( SR) from the perspective of the supervisor. Design A cross-sectional self-report questionnaire design was used with a repeated component for a subsample. Method Qualitative data from a previous study of the SR (collected by interviews with supervisors) were used to construct an 89-item self-report questionnaire measure (Supervisory Relationship Measure [ SRM]). This was administered to 267 clinical psychology supervisors involved in supervising UK trainee clinical psychologists. One hundred and thirty-four participants completed the measure a second time to establish its test-retest reliability. Results Principal components analysis was used. Five factors were identified and labelled 'safe base', 'supervisor commitment', 'trainee contribution', 'external influences', and 'supervisor investment'. Fifty-one items (comprising five subscales based on the factors identified) were selected for the final measure. Analyses revealed the SRM to have good internal consistency, good test-retest reliability, and good construct (convergent and divergent) validity. A preliminary test of predictive (statistical) validity (supervisor satisfaction with the relationship and trainee competence as perceived by the supervisor) yielded promising results. Conclusion The SRM is a valid and reliable measure of the SR from the supervisor perspective. It predicts supervisor satisfaction and preliminary evidence suggests that it may also predict trainee competence (as perceived by the supervisor). The findings are consistent with current theory on the SR. The SRM is, therefore, a promising tool for use in research, clinical, and training settings. Practitioner points The supervisory relationship measure (SRM) is a new psychometrically sound measure of the supervisory relationship (SR) with clinical and research uses., Clinically, it is a useful and structured way for supervisors to provide constructive feedback to their trainees., It can be used in conjunction with the Supervisory Relationship Questionnaire (SRQ) (completed by the supervisee) to support a dyadic discussion about clinical supervision., Currently the measure is only validated on Clinical Psychology trainees and should be used with caution with qualified staff and other professional groups., Participants were predominantly white British supervisors who chose to take part in an internet-based study and thus the sample may not be fully representative of the population. [ABSTRACT FROM AUTHOR]

Objectives This study explores associations between metacognitive beliefs and beliefs about voices in patients with severe auditory verbal hallucinations, and their hypothesized relationship with levels of depression and anxiety. Furthermore, it was hypothesized that metacognitive beliefs are better able to explain differences in levels of depression and anxiety, than beliefs about voices. Design Cross-sectional data were obtained from baseline measurements of a randomized controlled trial. All patients ( N = 77) met the criteria for a DSM- IV diagnosis within the schizophrenia spectrum. A correlation analysis was conducted to explore the associations between metacognitive beliefs and beliefs about voices. Regression analysis was performed to test the second hypothesis. Method Metacognitive beliefs were measured using the MCQ-30. Beliefs about voices were measured using the BAVQ-R. Furthermore, the Beck Depression Inventory-II and the Beck Anxiety Inventory were applied to measure depression and anxiety. All analyses were a priori controlled for gender and level of education. Results Significant associations were found between negative beliefs about voices and negative metacognitive beliefs. One of the metacognitive beliefs, that is, perceived uncontrollability and danger of thinking, proved to be a key variable in explaining differences in levels of depression and anxiety and seemed to have greater explanatory value than all of the beliefs about voices when analysed simultaneously. Conclusions The results offer modest support to models emphasizing the fact that metacognitive beliefs are a core feature in the development and maintenance of depression and anxiety in patients with severe auditory verbal hallucinations. Practitioner points Positive clinical implications: Further evidence for the importance of metacognitive beliefs., Specific emphasis on anxiety and depression in patients with severe hallucinations., Limitations Small sample size., Cross-sectional data only. [ABSTRACT FROM AUTHOR]

Objectives Comorbid obsessive-compulsive ( OC) symptoms in individuals with a primary diagnosis of schizophrenia are related to poorer cognitive performance and functional outcomes, but no study to date has assessed whether this comorbidity might also have implications for social cognition. The aim of the present study was to provide the first test of this possibility. Design and methods Individuals with schizophrenia ( n = 34) and demographically matched non-clinical controls ( n = 44) were assessed on two of the most important aspects of social cognitive function (1) facial affect recognition and (2) theory of mind, alongside more standard measures of cognitive function. Results The presence of OC symptoms was related to poorer performance on some of the cognitive measures, as well as one of the social cognitive measures (facial affect recognition). However, these relationships disappeared after controlling for scores on more general indices of schizophrenia psychopathology. Conclusions The presence of OC symptoms in schizophrenia is not only associated with increased cognitive impairment but also increased difficulties with at least some aspects of social cognitive function. However, these relationships appear to reflect the elevated levels of psychopathology seen in this cohort more generally, rather than being uniquely attributable to OC symptomatology. Practitioner Points The presence of obsessive-compulsive (OC) symptoms in chronic schizophrenia is not only associated with greater cognitive impairment but also with increased difficulties in at least some aspects of social cognitive function., These increased difficulties appear to reflect a more severe presentation of schizophrenia overall rather than the presence of OC symptoms specifically., A limitation of this research design was the inclusion of only chronic, medicated participants with schizophrenia. Individuals at early or more acute phases of schizophrenia may present with a different profile of impairment., Further research is needed to assess whether or not different results emerge where there is a comorbid diagnosis of obsessive-compulsive disorder (as opposed to sub-clinical OC symptoms). [ABSTRACT FROM AUTHOR]

Objectives Existing research studies suggest that children who are looked after by the State experience high levels of mental health difficulties and underachieve in many other domains. Few studies, however, aim to reflect the heterogeneity of these children and those who are performing well may be under-represented in the findings. This study aims to provide a more representative picture, offering novel data on resilience. Design A multidimensional, multiple-rater population-based study of looked after children. Method The entire population of looked after children aged 7-15 years ( n = 193) in one local authority was assessed in core domains; mental health, emotional literacy, cognitive ability and literacy attainment. Measures included the Strength and Difficulties questionnaire, Emotional Literacy Assessment and Intervention Inventory, and the British Ability Scales. The children's data were compared with general population norms and existing research studies. The incidence of resilience, defined by the fulfilment of positive exception criteria, was recorded. Children fulfilling positive exception criteria were then compared to the remaining children on key factors. Results The looked after children performed less well in all domains compared with general population norms. Sixteen per cent of children met the positive exception criteria. Positive performance on individual measures varied from 34% to 76%. A statistically significant association was found between positive exception classification and two factors; parental contact and mainstream schooling. Conclusions In general terms, this study supports the findings of previous research studies. However, evidence of positive exceptions across and within all domains cautions against overgeneralization of findings. The findings also implicate parental contact and mainstream education in the promotion of resilience. [ABSTRACT FROM AUTHOR]

Objective: Metacognitive beliefs (MCB) may guide information and attention processes, increasing affective and symptomatic reactions to stressful events. Cognitive self-consciousness (CSC; i.e., a preoccupation with one's thoughts) may increase awareness of MCB, potentially triggering the onset of psychotic symptoms. This study tested the hypotheses that (1), MCB would moderate affective and symptomatic reactions to stress in individuals at ultra-high risk (UHR) of developing psychosis, and (2), greater CSC would precede worsening in psychotic symptoms in individuals with strong MCB. Method: Twenty-seven individuals at UHR of developing psychosis completed a self-report diary when prompted by an electronic wristwatch several times each day for 6 days (experience sampling). Results: MCB moderated the association between affective, but not symptomatic, responses to social stress. CSC preceded the subsequent occurrence of hallucinations in individuals who reported strong beliefs about the need to control their thoughts. Conclusions: The data suggest that MCB sensitize an individual to social stressors. CSC may represent times where an individual is aware that their thoughts are uncontrollable, and therefore contradicting their MCB, motivating them to make an external attribution. The findings have implications for improving the effectiveness of interventions for people experiencing hallucinations. Practitioner Points Cognitive self-consciousness may precede the onset of hallucinations in individuals with a strong belief that they need to control their thoughts., Metacognitive beliefs may increase emotional reactions to everyday irritations and hassles., Limitations Only 27 individuals were included in the final analysis., Causality could not be established. [ABSTRACT FROM AUTHOR]

Objective. To further develop the Personal Beliefs about Illness Questionnaire (PBIQ), which reflects current constructs of social rank theory in relation to people experiencing psychosis. Method. Drawing on extensive clinical and research experience and after consultation with other mental health professionals and service users, 17 new items were added to 12 from the original 16 PBIQ questions. These made up five theoretical constructs (entrapment, loss, social marginalization, shame, and control). A total of 150 people who had just experienced a first episode of psychosis completed the newly devised PBIQ-R. To test the validity of its five subscales, a small sub-sample ( N= 66) for whom follow-up data was available also completed measures of depression, insight, and other social rank appraisals. Results. All five subscales of the PBIQ-R were found to be reliable, valid, and sensitive to change. Conclusions. Although the PBIQ-R was not designed to produce an overall 'personal beliefs about illness' score, its five subscales provide a rapid and valid method to assess and measure common psychological reactions to a first episode of psychosis. It will have relevance for use in older, multiple episode samples although further validation may be needed. [ABSTRACT FROM AUTHOR]

Objectives: To test the hypothesis that metacognitive beliefs are implicated in the development of distress associated with auditory verbal hallucinations (AVHs) rather than in their aetiology. Design: A cross sectional questionnaire design was used. Methods: Three groups of participants were recruited ( n= 20 in each group); clinical voice-hearers diagnosed with psychiatric disorders; non-clinical voice-hearers with no psychiatric history; and non-clinical participants with no history of voices or psychiatric disorder. All participants were screened for psychiatric symptomatology and completed a self-report measure of their metacognitive beliefs (MCQ-30). In addition, the two groups of voice-hearers were interviewed about dimensions of their voices (i.e., content, frequency, distress, and disruption). Results: The clinical group scored significantly higher than the two non-clinical groups on two subscales of the MCQ-30 (negative beliefs about worry concerning controllability and danger and negative beliefs about thoughts concerning need for control). There were no significant differences between the two non-clinical groups on MCQ-30 scores. Regression analyses revealed that the negative beliefs about need for control subscale of the MCQ-30 was the only significant predictor of voice-related distress, although this effect was no longer significant after controlling for the effect of group. Conclusions: These results are consistent with previous findings suggesting that metacognitive beliefs are not directly implicated in the aetiology of AVHs, but may be associated with psychological distress. Further research is however needed to determine whether metacognitive style may directly impact upon voice-related distress. [ABSTRACT FROM AUTHOR]