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OBJECTIVE Fatigue is a common and debilitating symptom of major depressive disorder (MDD). Cognitive behavioural therapy (CBT) is a recommended psychological treatment for adolescents with moderate to severe depression. This study explored the experience of CBT in fatigued adolescents with MDD. DESIGN A qualitative study was conducted using existing data from the qualitative arm of a large randomized control trial, the IMPACT study. METHODS Data were obtained from semi-structured interviews conducted after therapy. Participants were 18 adolescents (aged 13-18 years) who reached the clinical threshold for fatigue on diagnostic assessment before starting treatment. The data were analysed using thematic framework analysis. RESULTS Three themes and seven sub-themes were developed. Adolescents appeared to find taking part in initial sessions, engaging in ongoing sessions and completing homework challenging. Perceiving the therapist as genuine seemed to provide a sense of safety which enabled adolescents to open up in sessions. When the therapist was not perceived as genuine, adolescents appeared to find CBT less helpful. The structure of CBT appeared to enable treatment goals to be set, and facilitated an increase in meaningful activity. Ensuring that tasks were perceived as manageable and goals as achievable seemed important for participation. Cognitive restructuring appeared useful, although some adolescents tended to engage in distraction from thoughts as an alternative strategy. CONCLUSIONS This study provides an initial insight into how fatigued adolescents with MDD experience CBT. Further research is required to establish whether the themes are pervasive and relatedly, how best to treat depression in fatigued adolescents receiving CBT. PRACTITIONER POINTS Fatigued adolescents with depression found engaging in CBT sessions and therapeutic homework demanding. Establishing a collaborative therapeutic relationship, where the therapist was perceived as genuine, appeared helpful for participation. The structured approach to therapy, combined with flexibility, was experienced as helpful. Adolescents who perceived the pace of sessions to be manageable and therapeutic goals as achievable seemed to find CBT helpful overall. These findings provide insight into how fatigued adolescents with depression experience CBT and highlight the importance of being aware of fatigue and adapting therapy accordingly.

E. J. Langer's paper, 'The illusion of control' (1975), showed that people act in ways that suggest they hold illusory beliefs in their ability to control the outcome of chance-determined games. This highly cited paper influenced the emerging field of gambling studies, and became a building block for cognitive approaches to problem gambling. Over time, this work has inspired therapeutic approaches based on cognitive restructuring, preventative programmes focused upon gambling myths and regulatory scrutiny of skill mechanics in modern gambling products. However, the psychological mechanisms underlying the 'illusion of control' remain elusive.

Objective To develop a short, flexible, and comprehensive tool to measure psychological distress in caregivers of malignant mesothelioma (MM) patients: the Mesothelioma Psychological Distress Tool-Caregivers version (MPDT-C). Methods Based on a systematic review of the relevant literature, aspects associated with caregiver distress were derived. Expert researchers/clinicians developed a pool of items for each identified aspect. Content validity was assessed through a multiple mixed-methods approach. A multicenter study was conducted to explore the factorial structure of the 47-item MPDT-C through Bayesian factor analysis. Results The Bayesian exploratory factor analysis revealed an underlying three-factor structure. Factors were labeled Secondary Traumatic Stress, Engagement in Caring, and Meaningful Cognitive Restructuring. All scales showed sufficient reliability and corrected item-total correlations. Females scored higher than males for Engagement in Caring. Conclusions Taking care of malignant mesothelioma patients is a stressful process that influences the caregiver's physical, emotional, and social wellbeing. Our study offers preliminary evidence in support of the adequate psychometric properties of the MPDT-C, and these should now be replicated. Results suggest that the MPDT-C is a reliable tool with which to detect the psychological distress of this traumatized population.

Objective To examine the frequency of evidence-based treatment elements in popular smartphone apps for eating disorders (EDs), and to characterize the extent to which real-world users encounter different elements. Method We searched the Apple App Store and Google Play Store for apps offering treatment or support to individuals with EDs. Then, we created a codebook of 47 elements found in evidence-based treatments for EDs. We examined the presence or absence of each element within each ED app. We also acquired estimates of the monthly active users (MAU) of each app. Results The ED apps (n = 28) included a median of nine elements of empirically supported treatments (mean = 9.46, SD = 6.28). Four apps accounted for 96% of all MAU. MAU-adjusted analyses revealed that several elements are reaching more users than raw frequency tallies would suggest. For example, assessments were included in 32% of apps, but 84% of users used an app with assessments. Similar trends were found for cognitive restructuring (21% of apps, 56% of MAU), activity scheduling (39%, 57%), and self-monitoring (14%, 46%). Problem solving, exposure, and relapse prevention strategies, elements that are prominent in face-to-face empirically supported treatments, were rarely included in the apps. Discussion Evidence-based content is commonly included in ED apps, with certain elements reaching more users than others. Additionally, the top four apps are responsible for nearly all active users. We recommend that ED clinicians and researchers familiarize themselves with these apps-those that patients are most likely to encounter.

Background Depression becomes increasingly common in adolescence. Around 10%-20% of adolescents have a chronic illness, and they are more likely to experience depression. There is emerging evidence for cognitive behaviour therapy (CBT) interventions to treat depression in adolescents with chronic illnesses, yet no review has been undertaken of how these CBT interventions are delivered in practice. Methods We conducted a scoping review to summarise how CBT has been delivered in adolescents with chronic illness and depression. We included studies that evaluated CBT aimed at treating depression/depressive symptoms in adolescents with chronic illness. Searches were carried out across Embase and PsycNET. Results Twelve studies met our inclusion criteria. These included diabetes (n = 3), inflammatory bowel disease (n = 3), polycystic ovary syndrome (n = 2), chronic headache (n = 1), chronic pain (n = 1), chronic fatigue syndrome (n = 1) and Fanconi anaemia (n = 1). Adaptations made to the delivery of CBT included cognitive restructuring of illness-related thoughts, behavioural activation balancing illness-related and enjoyable activities, psychoeducation of the comorbidity and link between the chronic illness and depression, relationship building, skill building and parental or familial involvement. CBT was typically delivered by trained professionals with expertise in working with adolescents, who worked under supervision. Conclusions CBT for depression is commonly adapted for this population, and the nature of cognitions and behaviours targeted in CBT may typically depend on how the chronic illness presents. There is relatively little evidence to date, and a need for more research into the efficacy and effectiveness of treatments for adolescent depression in this vulnerable population specifically.

Objective Traumatic events in childhood have been implicated in the development of psychosis, but given that trauma is not in itself sufficient to cause psychosis, researchers have started to investigate other psychological constructs potentially involved in explaining this relationship. Given that self‐disgust as a transdiagnostic construct plays a role in the development/maintenance of a range of mental health difficulties, the objective of this study was to investigate whether self‐disgust mediates the relationship between childhood trauma and psychosis. Method A cross‐sectional quantitative study design was used. Seventy‐eight participants (Mage = 37.64 years, SDage = 11.57 years; 77% women; 88% White Caucasian) who reported experiencing clinical levels of psychosis were recruited using social media. The participants completed online survey measures of childhood trauma, self‐disgust, experiences of psychosis, self‐esteem, and external shame. The data were analysed using correlation and mediation analyses. Results Significant indirect effects of childhood trauma on both positive (β = .17, BC 95% CI [0.06, 0.30]) and negative symptoms (β = .26, BC 95% CI [0.14, 0.40]) of psychosis via self‐disgust were observed. These effects remained despite the inclusion of self‐esteem and external shame as control variables in the mediation models. Conclusion This study is the first to show a mediating role for self‐disgust in the relationship between childhood trauma and later psychosis. Although the findings should be considered preliminary until strengthened by further research, they nevertheless provide corroboration of the potential utility of self‐disgust as a transdiagnostic construct not only from a theoretical perspective, but also from its potential to inform formulation and interventions. Practitioner points When assessing individuals with psychosis, especially those with a trauma history explore experiences and feelings related to the construct of self‐disgust. Such experiences are likely to centre on feelings of repulsion towards the self/need for distance and might also manifest in the content of their psychotic experiences. Individuals with significant levels or experiences of self‐disgust are likely to need specific interventions to address these; while interventions seeking to improve positive aspects of their identity might well be useful, they are unlikely to address the specific maladaptive elements of self‐disgust. While self‐disgust‐focused interventions have not been widely researched, limited current evidence suggests cognitive restructuring and affirmation techniques might be useful.

As part of a larger clinical trial, this ecological momentary assessment (EMA) study pursued the main goal of demonstrating that the EMA method is sensitive to treatment effects of detached mindfulness and cognitive restructuring for obsessive-compulsive disorder (OCD). A second goal was to provide a descriptive analysis of OCD symptoms and influencing factors in participants' everyday lives. Thirty-nine participants were included in the final analyses. EMA sampling involved a smartphone and comprised 4 days with 10 random prompts per day both before (Pre-Treatment EMA) and after the completion of a 2-week clinical intervention of either detached mindfulness or cognitive restructuring (Post-Treatment EMA) that participants had been randomly allocated to. The EMA questionnaire included items on the frequency of obsessions, subjective burden due to obsessions, perceived current stress, emotions, and on the frequency of compulsions and other dysfunctional behaviors. Descriptive Pre-Treatment EMA results highlight the importance of compulsions and emotional states of tension/discomfort in OCD. Pre-Post comparisons showed a significant reduction of avoidance behavior, obsessions, and burden due to obsessions, with a nonsignificant trend also indicating a reduction of compulsions. There was no pre to post effect concerning emotions. This study adds to the existing research on OCD symptoms and offers further evidence in confirmation of established theoretical models of OCD. Also, our results can be taken as evidence for treatment sensitivity of the EMA method in OCD. Further research is needed to replicate, broaden, and generalize our results.

This paper describes implementation (fidelity, perceived acceptability) and tier 1 and tier 2 outcomes of a school-wide positive behavior interventions and supports approach (PBIS) including mental health supports at tier 2 in two K-8 urban schools. Interventions for tier 2 consisted of three manualized group cognitive behavioral therapy (GCBT) protocols for externalizing behavior problems, depression and anxiety. tier 1 and tier 2 interventions were implemented with fidelity but program feasibility for tier 2 was in question because school personnel needed a great deal of external support in order to implement the interventions. tier 1 interventions were associated with a decrease in office discipline referrals. Students participating in GCBT showed a significant decrease in mental health diagnostic severity at post-treatment. A discussion of perceived and actual implementation barriers and how they were addressed is provided. Implications for practice in low-income urban schools are discussed.

Problem Previous research suggests that the adult-focussed Clark and Wells (1995) model of social anxiety disorder (SAD) can be used to guide clinic-based treatment for adolescents. This single-case study (N = 1) investigated whether this model could also guide community-based outreach work for a 16-year-old female who was unable to attend clinic-based appointments due to social anxiety comorbid with panic and agoraphobia. Methods An experimental A-B-A design was used with three assessment-formulation sessions and 12 intervention sessions, focussing on exposure, cognitive restructuring, attention training, behavioural experiments and imagery rescripting. The Revised Child Anxiety and Depression Scale (RCADS), the Session Rating Scale (SRS) and the Goal Based Outcome form were administered at regular intervals. Findings and conclusions Social anxiety and panic scores reduced below the clinical threshold and the young person was able to leave home, travel independently (short-term goal) and re-engage with her social-family life (medium-term goal). SRS scores suggest that the intervention was acceptable and the therapeutic alliance was maintained throughout. In summary, this case study suggests that the Clark and Wells (1995) model of SAD can be used to guide community-based outreach work with adolescents unable to leave their home. Limitations and ideas for future research are discussed.

Background: Anxiety disorders have high prevalence in people with intellectual disabilities. In populations without intellectual disabilities, cognitive behavioural therapy is a first line psychological therapy for these presentations. There is no existing review of the range of methods and outcomes from intervention studies in this area. Method: A systematic review was carried out following guidance in the Cochrane handbook for systematic reviews of interventions. Results: Nineteen studies were identified. The majority of reports were descriptive case studies; the most frequently described presentations were non-specific anxiety disorders and post-traumatic stress disorder; the most frequently described cognitive techniques were psycho-education and interventions directly aimed at thoughts and beliefs and most studies reported positive outcomes, although the better controlled studies tended to report less comprehensive impacts. Conclusions: A range of presentations have been described although the area is still at a primarily descriptive stage. We discuss intervention structures and approaches that require further research. © 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd

Background Metaphors may provide clarity or identify hidden similarities between two ideas, and their use in cognitive restructuring can help maximise the effect of therapy information. This study aimed to determine whether metaphorical cognitive restructuring would produce a greater intervention effect in targeted mood and cognition than non-metaphorical restructuring. Methods Eighty-eight participants chose 25 problems of interest and wrote a self-report distress problem and were then randomly divided into a metaphorical restructuring group (N = 29), a literal restructuring group (N = 30), or a no restructuring problem restating group (N = 29). Participants first read a description of psychological distress ("problem") and then read a solution within one micro-counseling scenario. They were asked to evaluate their insightfulness during the intervention and evaluated mental distress and self-efficacy before and after the intervention. Results The mental distress of the metaphorical restructuring group significantly decreased after the intervention. Further, this group had greater insightfulness during the intervention, and this insightfulness could predict the reduction of negative affect after the intervention. Conclusions The use of metaphors can be of great value in eliciting a salient cognitive restructuring process and in alleviating mental distress.

Understanding the mechanisms and consequences of attributing socialness to artificial agents has important implications for how we can use technology to lead more productive and fulfilling lives. Here, we integrate recent findings on the factors that shape behavioral and brain mechanisms that support social interactions between humans and artificial agents. We review how visual features of an agent, as well as knowledge factors within the human observer, shape attributions across dimensions of socialness. We explore how anthropomorphism and dehumanization further influence how we perceive and interact with artificial agents. Based on these findings, we argue that the cognitive reconstruction within the human observer is likely to be far more crucial in shaping our interactions with artificial agents than previously thought, while the artificial agent's visual features are possibly of lesser importance. We combine these findings to provide an integrative theoretical account based on the "like me" hypothesis, and discuss the key role played by the Theory-of-Mind network, especially the temporal parietal junction, in the shift from mechanistic to social attributions. We conclude by highlighting outstanding questions on the impact of long-term interactions with artificial agents on the behavioral and brain mechanisms of attributing socialness to these agents.

Cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) is an effortful process requiring engagement in cognitive restructuring. Sleep disorders may lead to avoidance of effortful tasks and cognitive performance deficits. We explored whether sleep disorders, as assessed by polysomnography, were consistently associated with treatment response in combination with other factors. This study included 32 U.S. veterans who were examined both before and after CPT for combat-related PTSD. We employed a novel, case-comparative technique, fuzzy set qualitative comparative analysis (fsQCA), to identify combinations of fuzzy and crisp factors (recipes) that achieve a clinically significant outcome. Approximately one-quarter of cases experiencing clinically significant change were either (a) Vietnam era veterans without sedating medications, moderate sleep disordered breathing, and severe depression; or (b) non-Vietnam era veterans with sedating medications and without severe periodic limb movements (or significant periodic limb movement arousals). Recipes involving the absence of the relevant sleep disorder were associated with the highest coverage values. These results using fsQCA (a) provide valuable information about the heterogeneity of CPT response and (b) suggest that sleep disorders are important factors to consider in theoretical discussions of who responds to CPT for PTSD.

Selective Mutism (SM) is an under‐researched area of child development. While the incidence rate is low, the impact of this difficulty can be pervasive and can present as a significant risk for student mental health and wellbeing. The following article presents a case study focusing on parent‐student intervention for a preadolescent male, using an eclectic programme which blended psycho‐education, aspects of a manualised Cognitive Behavioural Therapy (CBT) programme, and specific selective mutism strategies. This article does not seek to evaluate the effectiveness of the programme but instead highlights practice considerations derived from systemic theoretical perspectives and present considerations for school staff. [ABSTRACT FROM AUTHOR]

This article presents an integrative framework for using cognitive behavior therapy through the lens of relational cultural theory. The authors provide an overview of cognitive behavior therapy and relational cultural theory, followed by suggestions on how to facilitate cognitive behavior therapy using the principles of relational cultural theory in college counseling. A case illustration is used to demonstrate the integration of cognitive behavior therapy and relational cultural theory.

Recent research has shown that unaccompanied young refugees (UYR) encounter a wide range of traumatic events during preflight, flight, and resettlement. Although many UYR are resourceful, many develop posttraumatic stress symptoms (PTSS). However, only a small number of vulnerable UYR have access to trauma-focused interventions. Trauma-focused group interventions, adapted to the needs of UYR, may be one way of improving their mental health. A total of 29 male UYR between 14 and 18 years of age, mainly from Afghanistan, participated in the evaluation study of a trauma-focused group intervention entitled Mein Weg (My Way). The intervention included six sessions of psychoeducation, relaxation, trauma narrative, and cognitive restructuring. Pre-post comparisons of PTSS assessed by the Child and Adolescent Trauma Screen (CATS) were used. At study entry, participants endorsed, on average, eight traumatic events. After the group intervention, the participants reported significantly fewer overall PTSS preintervention mean = 27.6, SD = 7.9; postintervention mean = 20.7, SD = 6.3; t(28) = 4.2, p = .001, Cohen's d = 0.97. Improvement was especially pronounced in the domains of reexperiencing and avoidance, as well as negative alterations in cognitions and mood. There were 14 participants preintervention and 7 postintervention who fulfilled the PTSD criteria. This pilot study presented initial evidence of the efficacy of the trauma-focused group intervention with regard to PTSS reduction.

BACKGROUND: Extended brief interventions for alcohol misuse are effective in the general population. The process of manualising the first ever such intervention for people with mild to moderate intellectual disabilities in the UK is the focus of this study. METHODS: The manual was an adaptation of existing manuals based on Motivational Enhancement and Cognitive Behaviour Therapy and was used in a feasibility randomized controlled trial, the EBI-LD study. The sessions were recorded and scored using an adapted version of the Yale Adherence and Competence Scale (YACS II). Feedback was provided by therapists. The trial is closed. Registered: isrctn.com; ISRCTN58783633. RESULTS: The quality of the sessions provided was rated as good. Therapists were able to cover all topics within each session. Main challenges included session duration and homework task completion. CONCLUSIONS: We recommend the duration of the sessions to be extended to 40 min to accommodate carers in the session and to enhance their support in homework task completion.

In his recent paper, Duttle (2016) showed that individuals with higher cognitive abilities show less overconfidence. In these findings, cognitive abilities were equated with an analytic cognitive style (as measured by a cognitive reflection test, or CRT), although recent works in the field of cognitive psychology suggest separating these two constructs. In particular, it is argued that the analytic cognitive style, but not cognitive abilities, decreases susceptibility to cognitive biases. Analyses of data from Duttle's study support this assertion. Implications for cognitive psychology and behavioural economics are discussed.

Meta-analytic studies have extracted 4 common elements among effective posttraumatic stress disorder treatments: cognitive restructuring and psychoeducation, a deliberate and continually improving therapeutic relationship, relaxation and self-regulation, and exposure via narrative of traumatic experiences. The authors present a clinical treatment structure catalyzing these active ingredients into discrete therapeutic tasks that counselors can focus on to maximize treatment effectiveness. The 4 tasks represent an attempt to identify critical competencies and baseline standards for the field of trauma counseling.

© 2017 The British Psychological Society Objective: Nearly half of children with intellectual disability (ID) have comorbid affective disorders. These problems are chronic if left untreated and can significantly impact upon future vocational, educational, and social opportunities. Despite this, there is a paucity of research into effective treatments for this population. Notably, one of the most supported of psychological therapies, cognitive behaviour therapy (CBT), remains largely uninvestigated in children with ID. The current review considers the neuropsychological profile of children and adolescents with mild to moderate ID, with a view to informing how CBT might best be adapted for children and adolescents with ID. Method: Narrative review of literature considering the neuropsychological profiles of children and adolescents with ID, with specific focus upon attention, memory, learning, executive functioning, and communication. Studies were identified through SCOPUS, PsycINFO, and PubMed databases, using combinations of the key words ‘intellectual disability’, ‘learning disability’, ‘neuropsychology’, ‘attention’, ‘learning’, ‘memory’, ‘executive function’, ‘language’, and ‘reading’. Results: Children with ID have significant deficits in attention, learning, memory, executive functions, and language. These deficits are likely to have a negative impact upon engagement in CBT. Suggestions for adapting therapy to accommodate these wide ranging deficits are proposed. Conclusions: There are multiple cognitive factors which need to be considered when modifying CBT for children who have ID. Furthermore, research is required to test whether CBT so modified is effective in this population. Practitioner points: Clinical implications. Effective ways of providing cognitive behavioural therapy (CBT) to children with intellectual disability (ID) is unclear. This study provides a framework of potential adaptations for clinical practice As rates of mental illness for children with intellectual disability are high, and rates of treatment provision low, it is hoped that the recommendations provided in this study will encourage more mental health practitioners to provide CBT to children with ID. Limitations. These recommendations are based only upon neuropsychological literature. Trialling the effectiveness of an adapted form of CBT for children and adolescents with ID is required. There are varying causes of intellectual disability, with differences in cognitive profiles. The utility of the recommendations made here may vary according to specific aetiologies.

BackgroundPeople with intellectual disabilities (ID) should be able to access the Improving Access to Psychological Therapies (IAPT) programme, currently a main provider of mainstream mental health services in England. IAPT offer cognitive behavioural therapy (CBT) to individuals experiencing mental health problems, although its effectiveness for people with ID, when delivered within IAPT, is unclear.MethodTen high-intensity therapists took part in semi-structured interviews, analysed using thematic analysis, regarding their experiences of delivering CBT to people with ID in IAPT.ResultsThe rigidity of the IAPT model appears to offer a poor fit with the needs of people with ID. Therapists appeared uncertain about how to modify CBT and highlighted training and service development needs.ConclusionsFindings suggest barriers to accessing IAPT largely remain unaddressed where people with ID are concerned. Services may need to reconsider what constitutes appropriate reasonable adjustments to ensure equitable access.

Acceptance and commitment therapy (ACT) is a modern form of cognitive behavior therapy that uses acceptance and mindfulness-based procedures to address clinical issues. A brief protocol of ACT was used with 3 children ages 10 and 11 years who were diagnosed with obsessive compulsive disorder (OCD). Results showed notable and clinically significant reductions of OCD across participants. These findings are noteworthy because the treatment was provided by a school psychologist, it is the first application of ACT for pediatric OCD, and it is one of a few studies using ACT with children. Limitations and future directions are discussed.

Cognitive dysfunction is a recognized feature of mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). Cognitive impairment is associated with poor overall functional outcome and is therefore an important feature of illness to optimize for patients’ occupational and academic outcomes. While generally people with BD appear to have a greater degree of cognitive impairment than those with MDD, direct comparisons of both patient groups within a single study are lacking. There are a number of methods for the assessment of cognitive function, but few are currently used in clinical practice. Current symptoms, past course of illness, clinical features, such as the presence of psychosis and comorbid conditions, may all influence cognitive function in mood disorders. Despite the general lack of assessment of cognitive function in clinical practice, clinicians are increasingly targeting cognitive symptoms as part of comprehensive treatment strategies. Novel pharmacological agents may improve cognitive function, but most studies of standard mood stabilizers, such as lithium and the anticonvulsants, have focused on whether or not the medications impair cognition. Non-pharmacological strategies, such as cognitive remediation and exercise, are increasingly studied in patients with mood disorders. Despite the growing interest in strategies to manage cognitive function, there is a paucity of high-quality trials examining either pharmacological or non-pharmacological modes of intervention.

Any type of behavioral change is an effortful process. Thus, the process of behavioral therapy, where clients seek to change maladaptive behavioral patterns, requires high-level cognitive engagement. It is unfortunate, then, that cognitive impairment is a feature of substance use disorders (SUDs), and especially because the domains that tend to be impaired are the very ones involved in the process of therapeutic behavioral change. In this review, we compare the cognitive profile that is frequently observed with chronic SUD with the skills that are required to initiate and sustain behavioral change during rehabilitation. Furthermore, we look to new therapeutic developments that seek to improve cognitive function. We propose that the use of these cognitive enhancing agents as adjuncts to behavioral therapy should help to overcome some of the cognitive barriers imposed by the disorder itself, and hence reduce the chance of relapse.

Background Evaluations of school-based anxiety prevention programmes have reported improvements in psychological functioning although little is known about their effect upon educational outcomes. Methods One thousand three hundred and sixty-two children from 40 primary schools in England took part in the randomised controlled trial, Preventing Anxiety in Children through Education in Schools. The trial investigated the effectiveness of a universal school-based cognitive behaviour therapy prevention programme, FRIENDS, delivered by health care staff or school staff compared with usual personal, social, health and education (PSHE) lessons. Self-report psychological outcomes and educational attainment on national standardised attainment tests in reading, writing and maths were collected 12 months postintervention. Analysis was performed at individual level using multivariable mixed effect models controlling for gender, type of intervention and school effect. Registered trial: ISRCTN: 23563048. Results At 12 months, anxiety reduced in the health-led FRIENDS group compared to school-led FRIENDS and PSHE. There were no between-group differences in academic performance regardless of gender, deprivation, ethnicity and additional educational needs. Conclusions School-based mental health interventions should assess psychological and educational outcomes. Further research should directly compare the effects of interventions led by health and school staff.

OBJECTIVE: Fear of falling is an important problem among older adults, even those with relatively low rates of objective fall risk, who are often overlooked as targets for intervention. METHOD: We developed and pilot tested a new intervention, Activity, Balance, Learning, and Exposure (ABLE), in a sample of 10 older adults with excessive fear of falling. The ABLE intervention integrates exposure therapy and cognitive restructuring with a home safety evaluation and an exercise program and is conducted in the home. In this pilot project, ABLE was jointly conducted by a physical therapist and a psychologist with expertise in geriatric anxiety disorders. RESULTS: The intervention was feasible and acceptable and resulted in decreases in fear and activity avoidance for most participants. One participant experienced an injurious fall. DISCUSSION: We learned a number of important lessons resulting in modifications to the inclusion criteria, assessments, and intervention over the course of this pilot study. RESULTS suggest that ABLE has promise for treating excessive fear of falling in the elderly and support testing the intervention in a larger randomized trial. Copyright © 2015 John Wiley & Sons, Ltd. Language: en

BACKGROUND: Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long‐term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family‐based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. OBJECTIVES: To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016. SELECTION CRITERIA: Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa. DATA COLLECTION AND ANALYSIS: Four review authors selected the studies, assessed quality and extracted data. We used a random‐effects meta‐analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures. MAIN RESULTS: We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly‐included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family‐based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low‐quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I(2) = 0%). However, at follow‐up, low‐quality evidence from only one study suggested this effect was not maintained. There was very low‐quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low‐quality evidence from only five trials for remission post‐intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I(2) = 37%) and at long‐term follow‐up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I(2) = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post‐intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I(2) = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post‐intervention or at follow‐up. AUTHORS' CONCLUSIONS: There is a limited amount of low‐quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or other psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well‐conducted trials.

Author(s): Benoit Allen, Kristy; Silk, Jennifer S; Meller, Suzanne; Tan, Patricia Z; Ladouceur, Cecile D; Sheeber, Lisa B; Forbes, Erika E; Dahl, Ronald E; Siegle, Greg J; McMakin, Dana L; Ryan, Neal D | Abstract: BackgroundChildhood anxiety is associated with low levels of parental autonomy granting and child perceived control, elevated child emotional reactivity and deficits in child emotion regulation. In early childhood, low levels of parental autonomy granting are thought to decrease child perceived control, which in turn leads to increases in child negative emotion. Later in development, perceived control may become a more stable, trait-like characteristic that amplifies the relationship between parental autonomy granting and child negative emotion. The purpose of this study was to test mediation and moderation models linking parental autonomy granting and child perceived control with child emotional reactivity and emotion regulation in anxious youth.MethodsClinically anxious youth (Nn=n106) and their primary caregivers were assessed prior to beginning treatment. Children were administered a structured diagnostic interview and participated in a parent-child interaction task that was behaviorally coded for parental autonomy granting. Children completed an ecological momentary assessment protocol during which they reported on perceived control, emotional reactivity (anxiety and physiological arousal) and emotion regulation strategy use in response to daily negative life events.ResultsThe relationship between parental autonomy granting and both child emotional reactivity and emotion regulation strategy use was moderated by child perceived control: the highest levels of self-reported physiological responding and the lowest levels of acceptance in response to negative events occurred in children low in perceived control with parents high in autonomy granting. Evidence for a mediational model was not found. In addition, child perceived control over negative life events was related to less anxious reactivity and greater use of both problem solving and cognitive restructuring as emotion regulation strategies.ConclusionBoth parental autonomy granting and child perceived control play important roles in the everyday emotional experience of clinically anxious children.

Insight is a salient psychotherapeutic progress but has rarely been measured in a controlled experimental setting. This study aimed to assess whether textual micro-counseling dialogue could validly evoke insight and to explore the characteristics of insight. The guessing riddle of cognitive psychology was used as a reference of the experimental paradigm. Specifically, textual micro-counseling dialogues applying cognitive restructuring techniques were presented. The participant first read a description of a psychological distress ("problem") and then an explanation ("solution"). Zero-, low-, and high-restructuring solutions were randomly matched to the problems and it was expected that they would trigger different levels of insight experiences. Experts and students evaluated the adaptability and emotional valence of problems, and the insightfulness, novelty, adaptability, and emotional valence of solutions. For both experts and students, different intensities of insightfulness were produced across high-, low- and zero-restructuring solutions. Novelty significantly discriminated the high-restructuring solutions from the other two solution types. Adaptability and emotional valence could discriminate the high- and low-restructuring solutions types from the zero-restructuring solution. Insightfulness had high correlations with novelty and adaptability. These results indicated that textual micro-counseling dialogues with a high-restructuring solution could validly produce the greatest insightfulness and the features of high-restructuring solutions may have reference meaning for improving psychotherapeutic effect.

Therapeutic alliance, modality, and ability to engage with the process of therapy have been the main focus of research into what makes psychotherapy successful. Individuals with complex trauma histories or schizophrenia are suggested to be more difficult to engage and may be less likely to benefit from therapy. This study aimed to track the in-session 'process' of working alliance and emotional processing of trauma memories for individuals with schizophrenia.The study utilized session recordings from the treatment arm of an open randomized clinical trial investigating trauma-focused cognitive behavioural therapy (TF-CBT) for individuals with schizophrenia (N = 26).Observer measures of working alliance, emotional processing, and affect arousal were rated at early and late phases of therapy. Correlation analysis was undertaken for process measures. Temporal analysis of expressed emotions was also reported.Working alliance was established and maintained throughout the therapy; however, agreement on goals reduced at the late phase. The participants appeared to be able to engage in emotional processing, but not to the required level for successful cognitive restructuring.This study undertook novel exploration of process variables not usually explored in CBT. It is also the first study of process for TF-CBT with individuals with schizophrenia. This complex clinical sample showed no difficulty in engagement; however, they may not be able to fully undertake the cognitive-emotional demands of this type of therapy. Clinical and research implications and potential limitations of these methods are considered.This sample showed no difficulties engaging with TF-CBT and forming a working alliance. However, the participants may not have achieved a level of active involvement required for successful cognitive restructuring of trauma memories. This discrepancy may relate to the mediating role of both working alliance and cognitive-emotional processing. The results underscore the importance of therapists understanding the relationship between alliance and other process factors which may be implicit in facilitating change.

Different types of therapy explain psychopathology and the effects of psychotherapy differently. Different explanations are, however, not necessarily mutually exclusive. Based on the idea that functional and cognitive explanations are situated at different levels, we argue that functional therapies such as traditional Behaviour Therapy (BT) and Acceptance and Commitment Therapy (ACT) are not necessarily incompatible with Cognitive Behaviour Therapy (CBT). Whether a functional and a cognitive therapy actually align depends on whether they highlight the same type of environmental causes. This functional-cognitive perspective reveals various differences and communalities among BT, CBT and ACT.

It is well established that many people with a diagnosis of schizophrenia experience significant problems with thinking skills such as concentration, memory, comprehension of social information, reasoning, and organization. These are often experienced by the individuals themselves as debilitating and demoralizing, but crucially, they also can limit people in their capacity to achieve fundamental life goals, such as working, having fulfilling relationships and living independently, which underpin well-being and a satisfactory quality of life. Cognitive remediation for schizophrenia is a psychological therapy that aims to improve thinking skills and consequently to benefit other more general areas of functioning and improve quality of life. This entry will summarize the foundational research background to the development and effectiveness of cognitive remediation; and the cutting-edge research into the developments in our understanding of the mechanisms of cognitive change and its relationship to improvements in everyday functioning, and new applications for cognitive remediation. The key aims for the field of cognitive remediation are now (i) to optimize its effectiveness in improving cognitive skills, but critically, in a way that ensures that these cognitive improvements have a measurable impact on other more general life skills, and (ii) to facilitate the wider dissemination of cognitive remediation into the clinical community. To achieve these goals, we need to establish an evidence-based, theoretical underpinning to cognitive remediation, including an understanding of the active ingredients and how best to deliver the therapy. Keywords: cognitive remediation; schizophrenia; cognition; neurocognition; social cognition; cognitive rehabilitation; social functioning

Mental imagery involves having an experience like perception but in the absence of a percept. We frequently have mental images such as when we remember an event or imagine the future. In psychological disorders, emotional mental images can flash to mind and be highly distressing, including traumatic memories or simulations of feared future events. However, emotional images have been neglected in research and therapy. This entry combines perspectives from cognitive science (mental imagery) and clinical psychology (psychological disorders). Cognitive science suggests that compared to verbal thoughts, mental imagery has a more powerful impact on emotion. Therefore, it is useful to ask about imagery in clinical assessment of emotional disorders. However, this approach has been largely restricted to PTSD (posttraumatic stress disorder). First, we illustrate that emotional mental imagery occurs across a wide variety of disorders. Second, by mapping the nature of imagery in disorders where it has been neglected (e.g., bipolar disorder), we may be able to import existing imagery therapy techniques (e.g., from PTSD) to improve treatment. Third, by drawing on cognitive science, we can capitalize on the properties inherent to mental imagery to suggest novel techniques. For example, maladaptive imagery may be reduced by cognitive tasks, which interfere with holding an image in mind. Also, adaptive imagery may be boosted by computerized training in generating positive imagery. Intriguingly, this opens the possibility of cognitively informed and computerized psychological treatments that may look rather different from traditional talking therapies. Keywords: mental imagery; psychological disorders; experimental psychopathology; imagery rescripting; emotion; trauma; bipolar disorder; depression; posttraumatic stress; cognitive science; cognitive behavior therapy; cognitive therapy