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Cognitive‐behavioural therapy for insomnia (CBT‐I) is the recommended first‐line therapy for adults with chronic insomnia disorder (ID), which is characterized by hyperarousal. Mindfulness‐based interventions (MBIs) are protocols aimed at stress reduction based on non‐judgmental attention control in the present moment. However, MBIs have been increasingly used without a clear scientific basis. The objective of this analysis was to examine if MBIs could be useful as a component of the CBT‐I therapeutic system through a systematic review and meta‐analysis of randomized controlled trials (RCTs) and non‐randomized studies (NRS) searched in PubMed, PsycINFO, Cochrane and WoS. The Insomnia Severity Index (ISI) was the primary outcome, while the Pittsburgh Sleep Quality Index (PSQI) and a composite sleep variable (CSV) were secondary outcomes. Thirteen articles corresponding to nine studies (three pragmatic RCTs, three explanatory RCTs and three NRS) were included. The omnibus test found that MBIs had a small to medium effect size on ISI nearing signification when comparing active control groups in the pretest–posttest period [Δ = 0.44, p = 0.07], a medium, non‐significant, effect size on PSQI [Δ = 0.52, p = 0.18], and a significant though small effect size on CSV [Δ = 0.05, p < 0.01]. No heterogeneity was found. The analysis could not demonstrate that MBIs, combined with CBT‐I components in some studies, positively affected ID in the general adult population. This was probably due to the lack of pragmatic designs and suitable measuring instruments. Recommendations are made for designing further studies to address these issues. [ABSTRACT FROM AUTHOR]

There has been a dramatic increase in remote psychotherapy since the onset of the COVID‐19 crisis. There is also expected to be an increase in mental health problems in the wake of the COVID‐19 pandemic. An increase in severe health anxiety (SHA) is particularly anticipated, for which cognitive–behavioural therapy (CBT) is a frontline treatment. However, it is unclear what interaction types are associated with outcome‐improvement in remote‐CBT (rCBT) for SHA. This study aimed to identify interaction types that predict outcomes and sudden gains in rCBT for SHA using initial therapy session content. Forty‐eight participants in rCBT for SHA had interactions at their first sessions categorized and rated in terms of patient activation: an individual's confidence and ability to manage their health. Multilevel modelling assessed whether early interaction types predicted session‐by‐session wellbeing. For participants experiencing sudden gains (n = 12) interactions at the session directly prior to the gain were similarly categorized and rated. The scores were then compared with ratings for the preceding session. A smaller proportion of early sessions was taken up with problem descriptions among those with greater outcome improvements. There was also a significant reduction in the proportion of the session spent describing problems in the session directly prior to a sudden gain, as compared with the previous session. Conversely, clients with better outcomes made more positive evaluations of themselves and therapy, noticed more positive changes and made more contributions to structuring interactions at initial sessions. Specific early interaction types predict session‐by‐session outcomes and precede sudden gains in rCBT for SHA. [ABSTRACT FROM AUTHOR]

The purpose of this review is to provide psychologists and other health care professional enough knowledge about available cognitive‐behavioural interventions for comorbidities in Parkinson's disease that include depression, anxiety, impulsive disorder, pain, and sleep disturbances. This review has clear clinical practical suggestions how to adapt psychological interventions and techniques to the motor and/or cognitive impairments of patients with Parkinson's disease, based on earlier available research results. Every available research that could be found with the help of search engines from Medline, Springer, PsychINFO, and Google Scholar, which used cognitive‐behavioural therapy to treat Parkinson's comorbidities, was cited and explained. Cognitive‐behavioural interventions and techniques are presented based on available research results for Parkinson's comorbidities. It is recommended to use treatment plans and interventions that are earlier suggested as efficient in patients with Parkinson's disease. Strongest available research based recommendations are available for depression and anxiety. There are only few available research studies that used cognitive and/or behavioural interventions for pain, impulsive disorder, or sleeping disturbances, except insomnia in Parkinson's disease. Cognitive‐behavioural therapy is safe to use and should be adapted to the specific needs of patients and with the scientific approved treatment interventions and techniques. Psychologists should be careful on how they adapt their treatment plan for patients. [ABSTRACT FROM AUTHOR]

Behavioural experiments are an important component of cognitive–behavioural therapy. However, there exists little up‐to‐date guidance on how to conduct these in people with a diagnosis of bipolar disorder. This paper provides recommendations on how to conduct behavioural experiments in this population. The aim is to upskill and empower clinicians to conduct behavioural experiments. The paper combines the expertise of senior clinicians working in the United Kingdom. The article starts by providing general advice on conducting behavioural experiments in people with bipolar disorder. It then offers specific examples of behavioural experiments targeting cognitions around the uncontrollability and danger of affective states, and related behavioural strategies, which have been implicated in the maintenance of bipolar mood swings. The article finishes by providing examples of behavioural experiments for non‐mood related difficulties that commonly occur with bipolar experiences including perfectionistic thinking, need for approval, and intrusive memories. Behavioural experiments offer a useful therapeutic technique for instigating cognitive and behavioural change in bipolar disorder. Conducted sensitively and collaboratively, in line with people's recovery‐focused goals, behavioural experiments can be used to overcome mood‐ and non‐mood related difficulties. [ABSTRACT FROM AUTHOR]

Although a number of manuals describe how to develop a cognitive‐behavioural case formulation (CBCF) to assist the clinician in developing and implementing tailored CB treatment for complex or comorbid cases, methods to evaluate and test functional hypotheses in the formulation for a particular case are not widely known or used. Thus, formulation‐based, tailored treatments for such cases are likely to be guided by case formulations of uncertain validity. The present article presents guidelines and choices available to the clinical trainee, researcher, or practitioner planning to use a person‐specific (PS) approach to testing CBCF hypotheses about functional relations between triggers, cognitions, and distress or dysfunction. This approach involves repeated assessments completed by the client using an individualized questionnaire that includes both nomothetic and idiographic items of greatest relevance to the client. Guidelines and options for developing this questionnaire and for data collection within the context of a collaborative therapist–client relationship are described. PS data analyses are then used to test case formulation hypotheses that vary in complexity from simple bivariate relations to complex dynamic mediation. A case example using this PS approach is described. Simpler options for the PS evaluation of a CBCF usable by practitioners and trainees as well as more complex options for clinical researchers are included. [ABSTRACT FROM AUTHOR]

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

Abstract: Currently, it is unknown whether treatment outcomes derived from randomized controlled trials (RCTs) of cognitive–behavioural therapy (CBT) for problem gamblers still hold when applied to patients seen in routine practice. Thus, data from an RCT of cognitive therapy versus exposure therapy for problem gambling versus patients of a gambling help service were compared. Assessments of problem gambling severity, psychosocial impairment, and alcohol use were undertaken at baseline and post‐treatment and evaluated within a counterfactual framework. Findings showed that the contrast between routine CBT for pokies and horse betting had a significant effect, indicative of a 62% lower gambling urge score if routine CBT recipients had all been horse/track betters opposed to gambling with “pokies.” However, the majority of contrasts indicated therapeutic outcomes achieved in routine CBT treatments were of equivalent robustness relative to RCT conditions. The present findings infer routine practice treatment outcomes are as efficacious as those generated in RCT contexts. [ABSTRACT FROM AUTHOR]

Objective There is growing recognition in psychology that wellness is more than the absence of disease and distress. Well-being has been defined in numerous ways. Two dominant models include Diener, Eunkook, Suh, Lucas and Smith's (1999) model of subjective well-being (SWB) and Ryff's (1989) model of psychological well-being (PWB). In contrast to the abundance of research investigating negative constructs and psychopathology in chronic fatigue syndrome (CFS), there has been a paucity of positive psychology studies. This study had two aims: to examine PWB and SWB and their relationship to symptoms in CFS and to compare PWB scores in a subgroup of the CFS sample to a matched control group. Method Chronic fatigue syndrome participants ( n = 60) completed self-report scales of PWB, SWB, fatigue, anxiety and depression. PWB scores in a subgroup of the CFS sample ( n = 42) were compared with those of a matched nonclinical control group ( n = 42). Results Correlations between scales of symptoms and well-being were complex. Well-being dimensions were largely independent of physical components of fatigue but strongly related to psychological components of fatigue and psychological distress. Multiple regression indicated that five dimensions of well-being uniquely predicted symptomatology. Compared with the control group, the CFS group scored significantly lower on five of Ryff's six PWB dimensions, with particularly marked deficits in personal growth, environmental mastery and self-acceptance. Conclusion This multidimensional assessment of well-being advances our understanding of CFS and offers new treatment targets. Future research must investigate whether interventions targeting theses well-being deficits can boost the efficacy of symptom-focused treatments. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Messages Previous psychological research into CFS has largely focused on the identification of negative constructs and CBT, a treatment that targets evidenced-based negative constructs, has demonstrated efficacy in reducing levels of fatigue and disability. However, the majority of people continue to experience psychiatric symptoms and excessive levels of fatigue post-treatment. Finding ways to enhance the efficacy of existing treatments is a clinical priority., There is evidence to suggest that in clinical populations, standard CBT is effective at reducing negative affect and thinking but fails to enhance low levels of positive affect and thinking, implying treatments may be more effective if they promote positive functioning alongside a reduction of negative functioning., Multidimensional models of well-being suggest that well-being is not a single phenomenon, and different psychological disorders may be characterized by varying well-being deficit profiles., Psychological well-being was found to be diminished in CFS participants compared with controls, with particularly marked deficits in personal growth, environmental mastery and self-acceptance, suggesting that these may be particularly important treatment targets., Well-being dimensions within the CFS group were largely independent of physical symptoms but strongly related to psychological symptoms, suggesting what may be causing low levels of well-being in CFS is largely psychological factors and the general impact of living with a chronic illness rather than symptom levels per se. [ABSTRACT FROM AUTHOR]

The concept of an 'internal supervisor' has been used in psychotherapy to describe the way in which the supervisory relationship is internalized and utilized by the supervisee. This research explores the possibility, and potential benefit, of training therapists to develop a 'compassionate internal supervisor'. A training programme was developed for trainee cognitive-behavioural therapists using adapted versions of compassion-focused therapy interventions. The training focused on guided imagery exercises and reflective practices undertaken for a 4-week period. Seven trainee cognitive-behavioural therapists were interviewed, utilizing a semi-structured format, regarding their experience of the training programme. The resulting transcriptions were analysed using Interpretative Phenomenological Analysis (IPA). The analysis identified six super-ordinate themes: (1) the varied nature of the supervisor image, (2) blocks and their overcoming, (3) increased compassion and regulation of emotion, (4) impact on cognitive processes, (5) internalization and integration, and (6) professional and personal benefit. The themes describe the varied ways in which participants created and experienced their compassionate supervisor imagery. Working with the personal blocks encountered in the process provided participants with a deeper understanding of the nature of compassion and its potential to support them in their training, practice and personal lives. The process and impact of 'internalizing' a compassionate supervisory relationship is described by participants and then discussed for potential implications for psychotherapy training and self-practice. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Compassion-focused therapy, and related compassionate-mind imagery exercises, can be adapted specifically to develop compassion in trainee psychotherapists., Creating, and engaging with, an 'ideal compassionate supervisor' in an imaginal form can support psychotherapy trainees in their clinical practice and development, their supervision and their personal lives., The cultivation of therapist self-compassion can reduce unhelpful cognitive processes such as worry, rumination and self-criticism whilst increasing self-reflection, attentional flexibility and approach behaviour., Identifying, and working with, blocks to compassion is important when cultivating clinician self-compassion, Therapist self-practice of compassion-focused exercises can provide important insights into the nature of compassion and its cultivation in clients [ABSTRACT FROM AUTHOR]

While there is a plethora of evidence for the efficacy of cognitive-behavioural therapy (CBT) in obsessive-compulsive disorder (OCD), studies on change factors of the therapeutic process that account for this success are scarce. In the present study, 155 participants with primary OCD were investigated during CBT inpatient treatment. The Yale-Brown Obsessive-Compulsive Scale-SR served as a measure of symptom severity. In addition, the following process change factors were measured: therapeutic relationship, experience of self-esteem during therapy, experience of mastery, problem actualization and clarification. All variables were assessed on a weekly basis for seven weeks. Linear mixed growth curve analyses were conducted to model the decrease of symptoms over time and to analyse whether the change factors predicted symptom reduction. The analyses revealed a linear decrease of symptoms with high inter-individual variation. Results further showed that increase in self-esteem and mastery experiences as well as the initial score on mastery experience and clarification predicted decrease on the Y-BOCS. We conclude that CBT therapists should focus on clarification in the very first sessions, and try to boost self-esteem and self-efficacy, which is related to mastery, throughout the treatment of OCD. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Increase in mastery and self-esteem experiences are associated with symptom decrease in obsessive-compulsive disorder (OCD) during cognitive-behavioural therapy (CBT)., Initial score of mastery experiences and problem clarification predict symptom decrease in OCD during CBT., CBT therapists should focus on problem clarification in the very first sessions and try to boost self-esteem and self-efficacy throughout the treatment of OCD. [ABSTRACT FROM AUTHOR]

Although pharmacological treatments can help alleviate mood symptoms in youth with paediatric bipolar disorder (PBD), residual symptoms still commonly persist. In many cases, these symptoms seriously affect the social and psychological development of children and adolescents suffering from PBD. Complementary interventions, such as psychosocial and psychoeducational treatments, can help children and their families manage mood regulation and other challenges throughout childhood and adolescence. However, most research on such interventions has focused on children, single-family psychoeducation, and individual cognitive behavioural therapy. The present study, conducted in Sweden, used a case-series design to explore whether child- and family-focused cognitive behavioural therapy (CFF-CBT) for PBD, adapted from children (8-12 years) to adolescents (13-18 years) and applied in a multi-family format, could help reduce symptoms, improve psychosocial functioning, increase parents' knowledge of and skills for coping with the disorder, and improve family expressed emotion for adolescents with PBD. Furthermore, we aimed to assess whether the effects of such CFF-CBT are maintained at a one-year follow-up. Seven adolescents and 11 parents in two multi-family groups received twelve sessions of CFF-CBT. Self-rating questionnaires and clinical observations were used to evaluate clinically significant changes for individual cases. The results suggest that CFF-CBT is feasible to deliver in an outpatient psychiatric setting and may be effective for developing parents' skills and knowledge for coping with PBD, increasing adolescents' psychosocial functioning, and improving family climate. The results are in line with previous findings on CFF-CBT for children with PBD, suggesting that CFF-CBT is a valuable adjunctive treatment for adolescents with PBD. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Preliminary evidence indicates that CFF-CBT (RAINBOW) is both acceptable and an important complement to pharmacological treatment for adolescents suffering from paediatric bipolar disorder (PBD)., Adolescent PBD populations show a high degree of comorbidity and individual clinical presentations that influence treatment results., Families show a large variation in ability to participate and benefit from RAINBOW treatment. Assessing and addressing pre-treatment environmental stressors and family climate during treatment is important for optimizing treatment effect., Symptoms of PBD fluctuate and new episodes can occur spontaneously. It is therefore important to follow PBD symptoms over time to draw more precise conclusions on treatment effects., When assessing treatment effects on psychiatric symptoms, social functioning, and family climate, it is important to use multiple rating sources, as ratings can vary considerably between adolescents, parents, and clinicians. [ABSTRACT FROM AUTHOR]

This study explores whether object relations (OR) functioning improves over the course of psychodynamic psychotherapy, and whether this improvement is related to symptom decrease as well as therapist technique. The sample consisted of 75 outpatients engaged in short-term psychodynamic psychotherapy at a university-based psychological service clinic. OR functioning was assessed pre- and post-treatment by independent raters using the Social Cognition and Object Relations Scale from in-session patient relational narratives. The Comparative Psychotherapy Process Scale was used to assess therapist activity and psychotherapy techniques early in treatment. Independent clinical ratings of global OR and psychotherapy techniques were conducted, and rater agreement was found to be in the excellent range. Regarding the results, global OR (overall quality and level of interpersonal functioning) significantly improved with large effect size after psychodynamic therapy. Change in global OR functioning was significantly and positively related to the incidence of psychodynamic techniques in early sessions, as were number of psychotherapy sessions attended. Patient self-reported reliable change in symptomatology and reliable change in global OR were significantly related as well. Multilevel model analyses confirmed pairwise correlations accounting for therapist effects on a variety of process-outcome measures, number of sessions attended, initial levels of psychiatric symptoms, employment of therapeutic techniques as well overall OR functioning at outcome. Limitations of the present study, future research directions and implications for clinical practice are also discussed. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Psychodynamic psychotherapy seems to be effective in improving object relations functioning., Consider use of psychodynamic techniques early in treatment with patients expressing more pathological object representations., Improvements in object relations functioning during psychodynamic psychotherapy are also related to adaptive changes in patient self-reported symptomatology., Therapist effects were also present for the study. As such therapists should be mindful to assess patient change and their use of technique at several points in treatment and flexibly adjust their approach as necessary. [ABSTRACT FROM AUTHOR]

The current open trial evaluated an inference-based approach (IBA) to the treatment of obsessive-compulsive disorder (OCD) across symptom subtypes and treatment-resistant cases. Following formal diagnosis through semi-structured interview by an independent evaluator, a total of 125 OCD participants across five major symptom subtypes entered a program of 24 sessions of treatment based on the IBA. An additional group of 22 participants acted as a natural wait-list control group. Participants were administered the Yale-Brown Obsessive-Compulsive Scale before and after treatment as the principal outcome measure, as well as measures of negative mood states, inferential confusion and obsessive beliefs. Level of overvalued ideation was assessed clinically at pre-treatment using the Overvalued Ideation Scale. After 24 weeks of treatment, 102 treatment completers across all major subtypes of OCD showed significant reductions on the Yale-Brown Obsessive-Compulsive Scale with effect sizes ranging from 1.49 to 2.53 with a clinically significant improvement in 59.8% of participants. No improvement was observed in a natural wait-list comparison group. In addition, IBA was effective for those with high levels of overvalued ideation. Change in inferential confusion and beliefs about threat and responsibility were uniquely associated with treatment outcome. The study is the first large-scale open trial showing IBA to be effective across symptom subtypes and treatment-resistant cases. The treatment may be particularly valuable for those who have previously shown an attenuated response to other treatments. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Psychological treatment based on the inference-based approach is an effective treatment for all major subtypes of obsessive-compulsive disorder., The treatment is equally effective for those with high and low levels of overvalued ideation., Treatment based on the inference-based approach may be particularly valuable for those who have shown an attenuated response to cognitive-behaviour therapy as usual. [ABSTRACT FROM AUTHOR]

The current study examines the efficacy of intensified group therapy for social anxiety disorder with fear of blushing. Task concentration training (TCT) and cognitive therapy (CT) were applied during one weekend and compared with a waiting list condition in a randomized controlled trial including 82 patients. On a second weekend, another intervention was added (resulting in TCT-CT and CT-TCT sequences) to examine order effects. Task concentration training and CT were both superior to the waiting list and equally effective after the first therapy weekend. Also, no differences were found between the sequences TCT-CT and CT-TCT at post-assessment. At 6- and 12-month follow-up, effects remained stable or further improved. At the 6-month follow-up, remission rates in completers, established by diagnostic status, were between 69% and 73%. Intensified group therapy is highly effective in treating social anxiety disorder with fear of blushing. Group formats for patients sharing a common primary concern may contribute to the dissemination of cognitive-behavioural therapy. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: This study focuses on blushing from fearful individuals within the SAD spectrum to improve evidence for treatment efficacy in those whose social fears are centred around observable bodily sensations., This study integrates task concentration training into the SAD model of Clark and Wells to combine two evidence-based treatments for SAD under one treatment model., This study uses an innovative format of brief, intensified group therapy, conducted on two full-day weekend group sessions delivered over two weekends, with strong observed effect sizes. [ABSTRACT FROM AUTHOR]

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

To offer insight into how cognitive-behavioural therapy (CBT) competence is defined, measured and evaluated and to highlight ways in which the assessment of CBT competence could be further improved, the current study utilizes a qualitative methodology to examine CBT experts' ( N = 19) experiences of conceptualizing and assessing the competence of CBT therapists. Semi-structured interviews were used to explore participants' experiences of assessing the competence of CBT therapists. Interview transcripts were then analysed using interpretative phenomenological analysis in order to identify commonalities and differences in the way CBT competence is evaluated. Four superordinate themes were identified: (i) what to assess, the complex and fuzzy concept of CBT competence; (ii) how to assess CBT competence, selecting from the toolbox of assessment methods; (iii) who is best placed to assess CBT competence, expertise and independence; and (iv) pitfalls, identifying and overcoming assessment biases. Priorities for future research and ways in which the assessment of CBT competence could be further improved are discussed in light of these findings. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: A qualitative exploration of experts' experiences, opinions and recommendations for assessing the competence of CBT therapists., Semi-structured interviews were conducted and analysed using interpretive phenomenological analysis., Themes identified shed light on (i) what to assess; (ii) how to assess; (iii) who is best placed to assess; and (iv) common pitfalls., Priorities for future research and ways in which the assessment of CBT competence could be further improved are discussed in light of these findings. [ABSTRACT FROM AUTHOR]

Objective The contributions of disorder severity, comorbidity and interpersonal variables to therapists' adherence to a cognitive-behavioural treatment (CBT) manual were tested. Method Thirty-eight patients received panic control therapy (PCT) for panic disorder. Trained observers watching videotapes of the sixth session of a 24-session protocol rated therapists' adherence to PCT and their use of interventions from outside the CBT model. Different observers rated patients' behavioural resistance to therapy in the same session using the client resistance code. Interview measures obtained before treatment included the Panic Disorder Severity Scale, the anxiety disorders interview schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and the structured clinical interview for DSM-IV, Axis II. Questionnaire measures were the anxiety sensitivity index at intake, and, at session 2, the therapist and client versions of the working alliance inventory-short form. Results The higher the patients' resistance and the more Axis II traits a patient had, the less adherent the therapist. Moreover, the more resistant the client, the more therapists resorted to interventions from outside the CBT model. Stronger therapist and patient alliance was also generally related to better adherence, but these results were somewhat inconsistent across therapists. Pretreatment disorder severity and comorbidity were not related to adherence. Conclusions Interpersonal variables, particularly behavioural resistance to therapy, are related to therapists' ability to adhere to a treatment manual and to their use of interventions from outside of the CBT model. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner message Patients' behavioural resistance to therapy may make it more difficult for cognitive-behavioural clinicians to adhere to a structured treatment protocol and more likely for them to borrow interventions from outside the CBT model., Patients' Axis II traits may make adherence to treatment CBT protocol more difficult, although whether this is true varies across therapists., Therapists' adherence to a structured protocol and borrowing from outside of the CBT model do not appear to be affected by disorder severity or Axis I comorbidity. [ABSTRACT FROM AUTHOR]

This paper presents a further step in the use and validation of a systematic, functional-analytic method of describing psychologists' verbal behaviour during therapy. We observed recordings from 92 clinical sessions of 19 adults (14women and 5men of Caucasian origin, with ages ranging from 19 to 51 years) treated by nine cognitive-behavioural therapists (eight women and one man, Caucasian as well, with ages ranging from 25 to 48 years). The therapists' verbal behaviourwas codified and then classified according to its possible functionality. A cluster analysis of the data, followed by a discriminant analysis, showed that the therapists' verbal behaviour tended to aggregate around four types of session differentiated by their clinical objective (assessment, explanation, treatment and consolidation). These results confirm the validity of our method and enable us to further describe clinical phenomena by distinguishing psychologists' classes of clinically relevant activities. Specific learningmechanismsmay be responsible for clinical change within each class. These issues should be analysed more closely when explaining therapeutic phenomena and when developing more effective forms of clinical intervention. [ABSTRACT FROM AUTHOR]

The role of therapeutic processes in predicting premature termination of psychotherapy has been a particular focus of recent research. The purpose of this study was to contrast outpatients who completed therapy and those who dropped out with respect to their self-reported in-session experiences of self-esteem, mastery, clarification and the therapeutic alliance. The 296 patients with mixed disorders were treated with an integrative form of cognitive-behavioural therapy without pre-determined time limit ( M = 20.2 sessions). Multilevel analyses indicated that patients who did not completetreatment reported, on average, lower levels of self-esteem, mastery and clarification and lower ratings of their therapeutic alliance in treatment in contrast to patients who completed therapy. Patient-reported change in self-esteem experiences over the course of treatment turned out to be the strongest predictor of dropout from psychotherapy or successful completion. When dropout occurred before the average treatment length was reached, patients reported fewer clarifying experiences as early as the first session and their ratings of the therapeutic alliance were characterized by an absence of positive development. Both of these aspects seem to be involved in patients' decisions to leave treatment early. The findings underscore the importance of the therapeutic process in understanding the mechanisms behind treatment dropout. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Analyses data from 296 patients at a private outpatient clinic in a routine practice setting (CBT)., Completer/dropout definition: presence or absence of measurement battery at post-assessment., Focuses on change in therapy processes by investigating post-session reports., Finds that positive changes in self-esteem experiences is the most robust predictor of dropout, followed by ratings of clarification experiences and the global alliance., In line with recent dropout research, these process indicators might help to detect therapeutic situations that are connected with psychotherapy dropouts. [ABSTRACT FROM AUTHOR]

Results from an earlier clinical trial comparing narrative therapy with cognitive-behavioural therapy (Lopes et al., 2013) suggested that narrative therapy is efficacious for depression. However, there were significant differences in symptom reduction on the Beck Depression Inventory-II, favouring cognitive-behavioural therapy, if dropouts were included in the analysis, suggesting that time to recovery or improvement would differ in both treatments. Contrarily, results showed that treatment assignment was not a predictor for differential effect. Using a survival analytic approach, it was found that four sessions were necessary for 50% improvement and 16 sessions for 50% recovery. Additionally, depressive symptoms changes occurred significantly faster than interpersonal changes, again regardless of treatment assignment. These results support previous findings of the dose-response literature and of the phase model of change, with the advantage of being specific to psychotherapy with depressive clients. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message For 50% of clients with major depressive disorder, it takes four sessions to improve and 16 sessions to recover, regardless of whether they were treated with narrative therapy or cognitive-behavioural therapy. For those clients who recover, they do so by session 11., Clients change depressive symptoms more consistently and much faster than they change interpersonal problems. For clients who will not recover during brief interventions and especially for clients who present strong interpersonal problems at onset, long-term treatment plans should be considered., More emphasis should be laid on symptomatic relief in the early stages of treatment and on interpersonal issues at later stages. [ABSTRACT FROM AUTHOR]

The need for effective training methods for enhancing cognitive-behavioural therapist competency is not only relevant to new therapists but also to experienced therapists looking to retain and further enhance their skills. Self-practice/self-reflection (SP/SR) is a self-experiential cognitive-behavioural therapy (CBT) training programme, which combines the experience of practicing CBT methods on oneself with structured reflection on the implications of the experience for clinical practice. In order to build on previous qualitative studies of SP/SR, which have mainly focused on trainee CBT therapists, the aim of the current study was to quantify the impact of SP/SR on the therapeutic skills of an experienced cohort of CBT therapists. Fourteen CBT therapists were recruited to participate in an SP/SR programme specifically adapted for experienced therapists. In the context of a quasi-experimental design including multiple baselines within a single-case methodology, therapists provided self-ratings of technical cognitive therapy skill and interpersonal empathic skill at four critical time points: baseline, pre-SP/SR and post-SP/SR and follow-up. Analysis of programme completers ( n = 7) indicated that SP/SR enhances both technical skill and interpersonal therapeutic skill. Further intention-to-treat group ( n = 14) analyses including both those who left the programme early ( n = 3) and those who partially completed the programme ( n = 4) added to the robustness of findings with respect to technical cognitive therapy skills but not interpersonal empathic skills. It was concluded that SP/SR, as a training and development programme, could offer an avenue to further therapeutic skill enhancement in already experienced CBT therapists. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message It was possible to quantify the positive impact of a self-practice/self-reflection (SP/SR) training and development programme within a cohort of experienced cognitive-behavioural (CBT) therapists., Through SP/SR, experienced CBT therapists can further enhance their self-perceived therapeutic skills in two key domains; technical cognitive therapy skills and interpersonal empathic skill., Further SP/SR studies should aim to incorporate objective measurement of therapeutic skill, ideally from more than one rating source. [ABSTRACT FROM AUTHOR]

This study explored the relationship between patient pre-treatment object relations (OR) functioning and psychodynamic techniques employed during two early sessions (third and ninth). The sample consisted of 76 outpatients engaged in short-term psychodynamic psychotherapy. Results showed that lower levels of patient pre-treatment OR functioning, particularly in the identity and affective domains, were related to a greater use of psychodynamic-interpersonal techniques in sessions. Patients who had more adaptive management of aggressive impulses were related to a greater use of cognitive-behavioural techniques by therapists. In addition, exploratory analyses between OR functioning and specific psychodynamic-interpersonal and cognitive-behavioural techniques showed that lower OR functioning in terms of affect, self-esteem, identity coherence, social causality, emotional investment in relationships as well as Global OR were significantly related to therapist focus on avoidance of important topics and affective changes during the session. Implications for clinical practice and Q1 future research are discussed. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message: Consider more frequent use of psychodynamic techniques early in treatment with patients expressing more pathological object representations, particularly when these deficits are in the affective and identity domains., Lower patient object relations functioning may necessitate an in session focus on issues that are avoided or uncomfortable early in treatment., Lower patient object relations functioning may necessitate the need to address and explore labile affective expressions in session as they occur early in treatment., When patients are able to more adaptively express or manage aggressive impulses early within psychodynamic psychotherapy consider the integration of problem solving, goal oriented, future focused (i.e., CB) techniques. [ABSTRACT FROM AUTHOR]

Predictors of outcome of inpatient treatment based on manualized cognitive-behavioural therapy (CBT) were examined for 147 adolescents with anxious-depressed school absenteeism assessed at discharge and at 2 months after the end of treatment. Outcome measures were regular school attendance and a wide variety of mental health problems rated by adolescents and parents. Socio-demographic data, clinical ratings/diagnosis and adolescent-reported and parent-reported mental health problems were examined as predictors. Regression analyses indicated that none of the variables were able to predict regular school attendance in a clinically relevant way. Adolescent-reported and parent-reported mental health problems at intake predicted these symptoms at both discharge and follow-up ( R2 between 0.31 and 0.61). Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message When treating anxious-depressed adolescents with chronic school absenteeism in an inpatient setting using CBT, socio-demographic data, clinical ratings, diagnosis or self-reported and parent-reported mental health problems cannot predict treatment outcomes on school absenteeism., Even severely impaired adolescents do not necessarily have the worst outcome in terms of high school absence rates., Severity of self-reported and parent-reported mental health problems at the start of inpatient treatment using CBT best predict these symptoms at discharge and at 2 months after the end of inpatient treatment. [ABSTRACT FROM AUTHOR]

Background Meta-analyses show benefits for patients from a combination of medication and cognitive-behavioural psychotherapy. However, it is still unclear whether or not additional cognitive-behavioural therapy (CBT) also produces a better treatment outcome in a naturalistic psychiatric setting. Methods Two-hundred six consecutively registered acute psychiatric inpatients with a unipolar depressive disorder were treated with additional CBT. This combined therapy was then compared with psychiatric primary care in an inpatient setting (clinical management). In addition to pharmacological treatment, 105 of the 206 patients also received symptom-focused CBT after hospitalization. Seventeen-item Hamilton Rating Scale for Depression (HAMD, primary outcome criterion), Beck Depression Inventory (BDI), Dysfunctional Attitude Scale, Clinical Global Impression Scale and the Global Assessment of Functioning were performed with all patients. Results Patients who were treated with additional CBT revealed a considerably greater reduction of depressive symptoms than in patients who received inpatient primary care only (HAMD: −22.21 versus −19.86, p = 0.027; BDI: 14.99 versus 11.36, p = 0.031). Moreover, remission rates were significantly higher (HAMD: 72% to 51%, p = 0.045; BDI: 58.8% versus 43.1%, p = 0.044) in the combined treatment group than in the primary care only group. Limitation The naturalistic design and the inconsistent pharmacological treatment are design flaws. Conclusion The results show that additional cognitive-behavioural treatment of depressive disorders notably improves outcome over standard procedure in acute psychiatric treatment. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message There is a need for treatment strategies to accompany medication. In the Sequenced Treatment Alternatives to Relieve Depression trial (STAR*D), only 33% of the patients reached remission criteria after the first antidepressant treatment step and only 50% after the second step., The strict inclusion criteria of randomized controlled trials often render their patient populations unrepresented. For an accurate view of treatment effectiveness, their results need to be complemented with results gained from trials in clinical practice., Additional cognitive-behavioural treatment notably improves treatment outcomes compared with standard treatments in the acute psychiatric treatment of depressive disorders., The results of this study under naturalistic conditions are an important addition to findings from randomized and controlled studies. [ABSTRACT FROM AUTHOR]

Compulsive buying (CB) is defined as extreme preoccupation with buying/shopping and frequent buying that causes substantial negative psychological, social, occupational and financial consequences. There exists preliminary evidence that group cognitive-behavioural therapy (CBT) is effective in the treatment of CB. The present pilot study made a first attempt to compare group CBT for CB with telephone-guided self-help (GSH). Fifty-six patients were allocated randomly to one of the three conditions: (1) group CBT ( n = 22); (2) GSH ( n = 20); and (3) a waiting list condition ( n = 14). The results indicate that face-to-face group CBT is superior not only to the waiting list condition but also to GSH. Patients who received GSH tended to have more success in overcoming CB compared with the waiting list controls. Given the sample size, the results must be considered as preliminary and further research is needed to address the topic whether GSH also could be a helpful intervention in reducing CB. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message Group cognitive-behavioural therapy is effective in the treatment of compulsive buying and superior to telephone-guided self-help., Preliminary data suggest that individuals who received telephone-guided self-help reported some improvement in compulsive buying compared with a waiting list condition., Further research is needed to investigate whether guided-self help is effective in overcoming compulsive buying. [ABSTRACT FROM AUTHOR]

Rosacea is a chronic skin disorder, characterized by persistent painful facial flushing and often accompanied by papules and pustules. To evaluate the psychological and social impacts of rosacea, 31 individuals with rosacea filled in the Blushing Propensity Scale, the Fear of Negative Evaluation Questionnaire, the Depression Anxiety and Stress Scale, the Social Interaction Anxiety Scale and the Social Phobia Scale. The questionnaires were also completed by 86 controls. Participants with extensive facial papules and pustules had higher blushing propensity, stress and social phobia scores than controls or others without papules or pustules. Childhood blushing was also reported more frequently by participants with rosacea than controls. Cognitive-behavioural therapy appeared to be helpful for managing social anxiety in three individuals with rosacea with a fear of blushing. These findings suggest that people with severe rosacea are anxious about the social consequences of blushing and generally prefer to avoid situations that might involve scrutiny by others. Persistent facial flushing could prime interoceptive cues of blushing or increase anxiety about facial coloration in provocative situations. Treatments that target fear of blushing may help to reduce social anxiety in people with severe rosacea. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message Blushing propensity scores are elevated in people with severe rosacea., Fear of blushing may contribute to social anxiety and avoidance in such cases., Cognitive-behavioural therapy for fear of blushing may help to reduce social anxiety in people with severe rosacea. [ABSTRACT FROM AUTHOR]

Padesky and Mooney's four-step Strengths-Based cognitive-behavioural therapy (CBT) model is designed to help clients build positive qualities. This article shows how it can be used to build and strengthen personal resilience. A structured search for client strengths is central to the approach, and methods designed to bring hidden strengths into client awareness are demonstrated through therapist-client dialogues. Development of positive qualities requires a shift in therapy perspective and different therapy methods from those employed when therapy is designed to ameliorate distress. Required adjustments to classic CBT are highlighted with specific recommendations for clinical modifications designed to support client development of resilience such as a focus on current strengths, the constructive use of imagery and client-generated metaphors. Although the focus of this article is on resilience, this Strengths-Based CBT model offers a template that also can be used to develop other positive human qualities. Copyright © 2012 Christine A. Padesky Key Practitioner Message A four-step strengths-based cognitive-behavioral therapy approach is presented., Therapists help clients identify existing strengths that are used to construct a personal model of resilience., Client-generated imagery and metaphors are particularly potent to help the client remember and creatively employ new positive qualities., Behavioral experiments are designed in which the goal is to stay resilient rather than to achieve problem resolution., Therapists are encouraged to use constructive therapy methods and interview practices including increased use of smiling and silence. [ABSTRACT FROM AUTHOR]

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

Complicated grief (CG), also called prolonged grief disorder, is a debilitating condition that can develop following a loss. There is growing evidence that cognitive-behavioural interventions are efficacious in the treatment of CG. The present preliminary study used data from 43 patients with CG who were randomly assigned to cognitive-behavioural therapy in an earlier treatment trial to explore (a) predictors of outcome of cognitive-behavioural therapy for CG and (b) the relationship between symptom improvement and changes in loss-related negative cognitions and avoidance behaviours. Analyses showed that worse treatment outcome was associated with lower education attainment, loss of a partner/child (instead of some other relative), early treatment discontinuation, less patient motivation and more severe CG symptoms at pre-treatment. As predicted, stronger reduction in CG severity was significantly associated with stronger reductions in negative cognitions and avoidance. Implications of these findings are discussed. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • Greater effectiveness of cognitive-behavioural therapy (CGT) for complicated grief (CG) seems to be associated with higher educational level, being confronted with losses other than the loss of a partner or child, completion (and not early discontinuation) of treatment and stronger motivation. • Longer CBT treatment may be needed for CG patients bereaved by the loss of a partner or child and mourners with more severe levels of CG. • Seeking ways to enhance patient motivation and adherence to treatment seems important to improve the effectiveness of CBT for CG. • Reduction in CG severity during CGT is associated with reduction in negative cognitions and avoidance behaviours. [ABSTRACT FROM AUTHOR]