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Background There is little understanding of the mental health impact for young people with long-term physical health conditions and mental health professionals’ experiences of supporting them during COVID-19. This service evaluation aimed to conduct a survey of the psychological services provided by mental health professionals in a paediatric hospital in relation to COVID-19. Method Clinical psychologists and assistant psychologists ( n = 76) across the hospital were asked to complete a survey, asking about their perceptions of COVID-19’s impact on patients and families and experiences of providing support during COVID-19. Open-ended survey questions were analysed qualitatively using framework analysis. Results Respondents described perceived impacts on patients and families around social isolation, school closure, family relationships, physical health, mental health, treatments and social support. Respondents’ experiences of providing mental health support during COVID-19 highlighted themes around providing remote/virtual support, workload and facilitators and barriers to their work. Conclusions Mental health professionals surveyed reported a complex mental health landscape in young people with long-term physical health conditions and their families during COVID-19. Service-wide involvement is needed to facilitate changes to support vital adaptations to remote/virtual working. Research on the mental health of young people with long-term physical health conditions and staff experiences of providing support is warranted.

BackgroundChildren and young people with long-term physical conditions have significantly elevated mental health needs. Transdiagnostic, brief psychological interventions have the potential to increase access to evidence-based psychological treatments for patients who attend health services primarily for physical health needs.ObjectiveA non-randomised study was conducted to assess the impact of brief, transdiagnostic psychological interventions in children and young people presenting at a drop-in mental health centre in the reception area of a paediatric hospital.Methods186 participants attending a transdiagnostic mental health drop-in centre were allocated to assessment and psychological intervention based on a clinical decision-making algorithm. Interventions included signposting, guided self-help based on a modular psychological treatment and referral to the hospital’s paediatric psychology service. The primary transdiagnostic mental health outcome measure was the parent-reported Strengths and Difficulties Questionnaire (SDQ), which was given at baseline and 6 months post-baseline.FindingsThere was a significant positive impact of attending the drop-in mental health centre on the SDQ (Cohen’s d=0.22) and on the secondary outcome measure of Paediatric Quality of life (Cohen’s d=0.55).ConclusionsA mental health drop-in centre offering brief, transdiagnostic assessment and treatment may reduce emotional and behavioural symptoms and improve quality of life in children and young people with mental health needs in the context of long-term physical conditions. A randomised controlled trial to investigate the specificity of any effects is warranted.Clinical implicationsDrop-in centres for mental health needs may increase access and have beneficial effects for children and young people with physical conditions.

There are potent evidence-based psychological treatments for youth with mental health needs, yet they are rarely implemented in clinical practice, especially for youth with mental health disorders in the context of chronic physical illness such as epilepsy. Implementation science, the study of the translation of research into practice, can promote the uptake of existing effective interventions in routine clinical practice and aid the sustainable integration of psychological treatments with routine health care. The aim of this report was to use four implementation science methods to develop a version of an existing effective psychological treatment for mental health disorders [the Modular Approach to Treatment of Children with Anxiety, Depression or Conduct Problems (MATCH-ADTC)] for use within paediatric epilepsy services: (a) literature search; (b) iterative focus groups underpinned by normalisation process theory; (c) Plan–Do–Study–Act methods; and (d) qualitative patient interviews. Findings: Three modifications were deemed necessary to facilitate implementation in children with both mental health disorders and epilepsy. These were (a) a universal brief psychoeducational component addressing the relationship between epilepsy and mental health; (b) supplementary, conditionally activated interventions addressing stigma, parental mental health and the transition to adulthood; and (c) additional training and supervision. The intervention needed relatively little alteration for implementation in paediatric epilepsy services. The modified treatment reflected the scientific literature and the views of clinicians and service users. The multi-method approach used in this report can serve as a model for implementation of evidence-based psychological treatments for children with mental health needs in the context of other chronic illnesses.

Children with genetic conditions may experience significant mental health difficulties such as anxiety and challenging behaviour. However, understanding of the feasibility and effectiveness of psychological interventions for emotional and behavioural problems in the context of genetic conditions is limited. Low-intensity psychological interventions have demonstrated promise in paediatric populations and may be able to address their mental health difficulties. A case series design was used to assess the feasibility of low-intensity interventions for emotional and behavioural difficulties in children and young people with genetic conditions recruited from a mental health drop-in centre at a tertiary hospital. Participants received seven weekly sessions with a trained practitioner. The intervention was based on existing modular treatments and evidence-based self-help materials. Feasibility and treatment satisfaction were assessed, as well as measures of symptoms of anxiety and challenging behaviour, treatment goals and quality of life, at baseline, during treatment and 6-month follow-up. Five participants received treatment for challenging behaviour, one for anxiety, and one for obsessive compulsive disorder. All participants completed treatment. Clinically significant change in the SDQ Total score was found in three participants. All participants demonstrated progress in goals and symptoms of emotional and behavioural difficulties over the course of treatment. Low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions is feasible, acceptable and potentially beneficial. Further research is warranted to examine the effectiveness of the intervention and its use in clinical paediatric settings. Key learning aims (1) To gain a basic understanding of low-intensity psychological intervention in children and young people with genetic conditions. (2) To enhance understanding of the practicalities and acceptability of delivering low-intensity psychological intervention to children and young people with genetic conditions and co-morbid emotional and behavioural difficulties. (3) To learn about the potential clinical benefits of delivering low-intensity psychological intervention to children and young people with genetic conditions in the context of stepped care.

Background Children with chronic health conditions and their parents are at greater risk of developing emotional and behavioural problems compared to their physically healthy peers. The psychological impact on parents is crucial to understand given the relationship between parental mental health and child emotional and behavioural difficulties. This study was part of a broader research project examining the acceptability, feasibility and impact of a ‘Mental Health and Psychological Wellbeing Drop‐in Centre’ in a paediatric hospital providing access to support and intervention for children and their families. This paper aimed to investigate the impact of the centre on parents (n = 148). Methods Parental anxiety and depression were assessed using the GAD‐7 and PHQ‐9 at baseline and 6‐month post‐baseline. Child mental health was assessed using the parent‐report Strengths and Difficulties Questionnaire (SDQ). If parents had significant mental health needs, a brief intervention/signposting to relevant services was provided. Results At baseline, 48% of parents scored above clinical threshold for anxiety and 41% for depression, and parent reported child SDQ scores were correlated with parental anxiety and parental low mood. Self‐reported parental anxiety and low mood decreased at 6‐months post‐baseline (parental anxiety: mean decrease = 2.29 [1.22–3.36], d = 0.38; parental low mood: mean decrease = 1.81 [0.64–3.00], d = 0.28). There were no significant correlations between change in parent reported child wellbeing and changes in parental low mood and anxiety between baseline and 6‐month post‐baseline. Conclusions Assessing and providing a brief treatment to address the mental health needs of parents of children with comorbidity may bring important benefits. It is recommended that children's mental health services consider assessment of parental mental health as part of routine care.

Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.

Background Paediatric patients being treated for long-term physical health conditions (LTCs) have elevated mental health needs. However, mental health services in the community are difficult to access in the usual course of care for these patients. The Lucy Project – a self-referral drop-in access point—was a program to address this gap by enrolling patients for low-intensity psychological interventions during their treatment for LTCs. In this paper, we evaluate the cost-effectiveness of the Lucy Project. Methods Using a pre-post design, we evaluate the cost-effectiveness of the intervention by calculating the base-case incremental cost-effectiveness ratio (ICER) using outcomes data and expenses recorded by project staff. The target population was paediatric patients enrolled in the program with an average age of 9 years, treated over a time horizon of 6 months. Outcome data were collected via the Paediatric Quality of Life Inventory, which was converted to health utility scores using an instrument found in the literature. The QALYs were estimated using these health utility scores and the length of the intervention. We calculate a second, practical-case incremental cost-effectiveness ratio using streamlined costing figures with maximum capacity patient enrolment within a one-year time horizon, and capturing lessons learned post-trial. Results The base-case model showed an ICER of £21,220/Quality Adjusted Life Years (QALY) gained, while the practical model showed an ICER of £4,359/QALY gained. The practical model suggests the intervention garners significant gains in quality of life at an average cost of £309 per patient. Sensitivity analyses reveal use of staff time was the greatest determinant of the ICER, and the intervention is cost-effective 75% of the time in the base-case model, and 94% of the time in the practical-case model at a cost-effectiveness threshold of £20,000/QALY gained. Conclusions We find the base-case intervention improves patient outcomes and can be considered cost-effective according to the National Institute for Health and Care Excellence (NICE) threshold of £20,000—£30,000/QALY gained, and the practical-case intervention is roughly four times as cost-effective as the base-case. We recommend future studies incorporate a control group to corroborate the effect size of the intervention.

Young people with cancer are at increased risk of psychological difficulty; yet there is little research on their experiences of low mood or depressive symptoms to help inform treatment interventions. This qualitative study explored experiences and opinions of low mood or depression in young people with cancer, how their mood related to developmental challenges, strategies used to cope, and how services could improve support. Nineteen young people diagnosed and treated for cancer completed semistructured interviews. Transcripts were thematically analyzed using the framework approach, and analysis produced eight themes, organized into three domains: “A Harder Time of Life,” “Interpersonal Impact of Cancer,” and “Learning to Understand and Describe Low Mood,” Participants interviewed experienced low mood during cancer and predominantly felt “low mood” was a helpful term to describe their emotions. There were similarities and variations in their reported mood compared with clinical depression. The developmental challenges of being a young person with cancer negatively affected their mood. Participants used a variety of different coping strategies to manage these challenges. Young people were clear that they would like others to help them understand negative emotions experienced through cancer are normal to feel and support for low mood to be accessible and available.

Young people with cancer are at increased risk of depression, yet evidence-based psychological interventions that are tailored to the specific needs of young people with cancer are scarce, and depression in this group may be particularly challenging to recognize and treat. The aims of this study were to (1) explore the views of health professionals in recognizing and treating low mood in young people with cancer and (2) identify the key components of an effective online treatment package for depression in this population.Eighteen NHS health professionals with a range of professional backgrounds working directly with young people with cancer were interviewed using a semi-structured interview schedule. Responses were analyzed using thematic analysis.Five themes emerged: (1) one size doesn't fit all-the nature of depression is complex and varied, and symptoms fluctuate greatly in relation to physical health; (2) distress is completely understandable-it is important not to pathologize a normal reaction; (3) a stepping stone intervention-online interventions may promote engagement with face-to-face therapy; (4) connecting with others-the intervention should promote sharing experiences with others to reduce isolation; and (5) ownership and empowerment-lack of independence may be a cause of distress, and young people should have control of the intervention.The nature of depression in young people with cancer is complex and multifaceted. Online guided self-help may be useful when added as a component or first step of a treatment package including face-to-face talking therapies.

Objectives The primary aim of this qualitative study was to explore the views of health professionals, with little previous clinical mental health training, of an adapted modular cognitive-behavioral intervention (MATCH-ADTC) for common mental health problems in children and young people with epilepsy. Methods Healthcare Professionals (HCPs) and their supervisors were interviewed at the start (n = 23) and end (n = 15) of the six-month training period. The interviews were transcribed verbatim and analyzed using thematic analysis. Results Three higher order themes with sub-themes were identified: (1) strengths of the MATCH-ADTC content and manual; (2) expectations of the treatment; and (3) improving practice with MATCH-ADTC. Overall impressions of the training and treatment were largely positive, with HCPs viewing MATCH-ADTC as an acceptable treatment for the families that they worked with. HCPs highlighted some challenges in delivering an integrated service, particularly relating to the time commitment involved and their own confidence in delivering the intervention, as many participants did not have a mental health background. Conclusions The findings suggested that the intervention and training was acceptable to HCPs working in pediatric epilepsy services, and confidence grew over the six-month training period. Further research is needed to understand how to best train, supervise, and support HCPs in pediatric epilepsy services to deliver mental health treatments.

The general population has experienced a significant elevation in fear and anxiety during COVID-19 both as a direct result of the virus but also due to measures taken to prevent it spreading, such as the need to stay inside and increase hand-washing. Lockdown has been used in many/most countries to prevent widespread infection. The advice and imposed actions are necessary to prevent the virus from spreading, but they might exacerbate the problems experienced by people with a preexisting anxiety-related disorder. The treatment of anxiety-related disorders can be provided while in quarantine. Staying at home in self-isolation does not preclude obtaining psychological treatment for anxiety-related disorders. Dealing with cognitive biases, over-estimations of threat, intolerance of uncertainty, inflated responsibility and excessive safety behavior, are useful clinical directions.

Behavioural difficulties impact greatly upon quality of life for children with chronic illness and their families but are often not identified or adequately treated, possibly due to the separation of physical and mental health services. This case study describes the content and outcomes of guided self-help teletherapy for behavioural difficulties in a child with epilepsy and complex needs using an evidence-based behavioural parenting protocol delivered within a paediatric hospital setting. Behavioural difficulties and progress towards the family’s self-identified goals were monitored at each session. Validated measures of mental health and quality of life in children were completed before and after intervention and satisfaction was measured at the end of treatment. Measures demonstrated clear progress towards the family’s goals and reduction in weekly ratings of behavioural difficulties. This case demonstrates that a guided self-help teletherapy approach delivered from within the paediatric setting may be one way of meeting unmet need.

Background Mental health disorders in the context of long-term conditions in children and young people are currently overlooked and undertreated. Evidence-based psychological treatments for common childhood mental health disorders (anxiety, depression and disruptive behaviour disorders) have not been systematically evaluated in young people with epilepsy despite their high prevalence in this population. The aim of this multi-site randomised controlled trial is to determine the clinical and cost-effectiveness of adding a modular psychological intervention to usual care for the mental health disorders in comparison to assessment-enhanced usual care alone. Methods In total, 334 participants aged 3–18 years attending epilepsy services will be screened for mental health disorders with the Strengths and Difficulties Questionnaire (SDQ) and the diagnostic Development and Wellbeing Assessment (DAWBA). Those identified as having a mental health disorder and consenting to the trial will be randomised to either receive up to 22 sessions of the modular psychological intervention (MATCH-ADTC) delivered over the telephone over 6 months by non-mental health professionals in addition to usual care or to assessment-enhanced usual care alone. Outcomes will be measured at baseline, 6 months and 12 months post-randomisation. It is hypothesised that MATCH-ADTC plus usual care will be superior to assessment-enhanced usual care in improving emotional and behavioural symptoms. The primary outcome is the SDQ reported by parents at 6 months. Secondary outcomes include parent-reported mental health measures such as the Revised Children’s Anxiety and Depression Scale, quality of life measures such as the Paediatric Quality of Life Inventory and physical health measures such as the Hague Seizure Severity Scale. Outcome assessors will be blinded to group assignment. Qualitative process evaluations and a health economic evaluation will also be completed. Discussion This trial aims to determine whether a systematic and integrated approach to the identification and treatment of mental health disorders in children and young people with epilepsy is clinically and cost-effective. The findings will contribute to policies and practice with regard to addressing mental health needs in children and young people with other long-term conditions. Trial registration ISRCTN ISRCTN57823197. Registered on 25 February 2019.

Background Children and young people with long term physical health conditions (LTC) are known to have higher levels of co-morbid mental health problems than medically healthy children. Evidence-based treatments for mental health problems are effective in children who also have an LTC. A drop-in centre in a paediatric hospital, delivering a range of interventions including onward referral, signposting and guided self-help, may be one way to complement existing mental health services as part of a stepped-care approach. The aim of this study was to understand patients’ perspectives of the centre. Methods 128 patients attending a drop-in centre at Great Ormond Street Hospital were invited to participate. Overall, 35 participated in semi-structured interviews (either in person or by phone) exploring their experience of the drop-in centre. Interviews were audio-recorded, transcribed, and analysed using Framework analysis. Results Overall, participants found the drop-in centre highly acceptable and reported a positive experience. Reasons for this varied, but broadly focused around four areas:(1) Choice in how to access the intervention and feeling empowered afterwards; (2) Having someone to talk to who could provide them with practical support; (3) Integration and parity of physical and mental health care; (4) The intervention being sufficient to meet their needs and quick to access. Discussion Participants found the intervention feasible and acceptable. A drop-in centre in a paediatric hospital appears to be a positive and valued adjunct to supplement existing mental health services at GOSH.

The coronavirus pandemic has highlighted the need for remote technologies to be used in child and adolescent mental health services. With the UK being placed in lockdown one week before a scheduled 'face-to-face' low-intensity CBT training day due to COVID-19, there was a need for rapid adaptations to be made to the content, structure and format of a training day for practitioners in mental health services, to suit the online environment. The content covered the core areas of low-intensity CBT in children and adolescents. Findings showed that the one-day low-intensity training day increased knowledge and understanding in all key areas measured, and was positively received, providing further evidence for the effectiveness and acceptability of remote delivery. Given discussed benefits of remote delivery, as well as rapid developments in technologies helping to address some of the challenges raised, going forward, remote delivery could continue to be beneficial for increasing access to much needed evidence-based interventions.

ObjectiveTo determine rates of psychiatric comorbidity in a clinical sample of childhood movement disorders (MDs).DesignCohort study.SettingTertiary children’s hospital MD clinics in Sydney, Australia and London, UK.PatientsCases were children with tic MDs (n=158) and non-tic MDs (n=102), including 66 children with dystonia. Comparison was made with emergency department controls (n=100), neurology controls with peripheral neuropathy or epilepsy (n=37), and community controls (n=10 438).InterventionsOn-line development and well-being assessment which was additionally clinically rated by experienced child psychiatrists.Main outcome measuresDiagnostic schedule and manual of mental disorders-5 criteria for psychiatric diagnoses.ResultsPsychiatric comorbidity in the non-tic MD cohort (39.2%) was comparable to the tic cohort (41.8%) (not significant). Psychiatric comorbidity in the non-tic MD cohort was greater than the emergency control group (18%, pConclusionsPsychiatric comorbidity is common in non-tic MDs such as dystonia. These psychiatric comorbidities appear to be under-recognised and undertreated.

Background: Epilepsy is one of the most common chronic paediatric conditions. Children and young people with epilepsy are at a significantly higher risk of developing mental health problems relative to the general population, yet the majority of these problems are unrecognised and under-treated in clinical practice. Although there is little epilepsy-specific guidance as to what interventions to use, researchers suggest there is no reason why clinicians should not be using the evidence base. Given the poor prognosis of untreated mental health difficulties, this cohort study sought to identify what psychological treatment young people with epilepsy with mental health needs receive in routine practice. Methods: Participants were children and young people aged 3 to 18 attending paediatric neurology clinics. The parents of those children who met threshold for impairing symptoms on the Strengths and Difficulties questionnaire were asked to complete the Development and Well-being Assessment (DAWBA), an online clinical assessment designed to generate psychiatric diagnoses. Participants who met clinical threshold for a disorder according to the DAWBA were provided with a bespoke measure asking questions regarding their experience with treatment for mental health support. Results: 16 of the 46 parents who completed the DAWBA reported that they had experienced previous or current support for their child’s mental health difficulties. The mental health support offered to families was highly variable, inadequate and often not clearly compliant with existing UK National Institute for Health and Clinical Excellence (NICE) guidelines for mental health treatment in children and young people. Conclusions: The present study demonstrates the inconsistency and inadequacy of mental health provision for children and young people with epilepsy. Future work should explore reasons for the treatments offered failing to adhere to existing guidance for mental health difficulties in children, as well as possible solutions to this.

Background Loneliness is a transdiagnostic clinical phenomenon that can significantly impact mental health and well-being across the lifespan. Objective The aim was to combine existing theory and evidence-based treatment approaches to propose a comprehensive transdiagnostic cognitive-behavioral analysis of the maintenance of chronic loneliness relevant across disorders, age groups, and populations. Method A distillation and matching model-framework approach was taken to identify interventions designed to reduce loneliness. Eligible studies were coded for the presence of practice elements. The findings were combined with an analysis of the broader literature on loneliness and psychopathology to derive a comprehensive cognitive-behavioral analysis of the maintenance of loneliness over time across populations. Results The search yielded 11 studies containing 14 practice elements with relative frequencies ranging from 7% to 64%. The identified practice elements target putative mechanisms such as negative interpersonal appraisals, anxiety, and social skills deficits. Counterproductive behavior and cognitive processes such as self-focused attention were identified as maintenance factors based on the broader literature. A modular transdiagnostic model with multiple pathways is proposed to be consistent with the existing theoretical and treatment literature. Conclusions Combining the distillation and matching model framework with existing theory from the literature is a novel approach for developing a model of factors that maintain loneliness over time. The model has varying treatment implications for different populations including children with autism spectrum disorders and bereaved older adults. Targeting transdiagnostic processes has the potential to transform interventions for loneliness across a range of formats and settings. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

ObjectiveWe aimed to test the feasibility of using an online parent-completed diagnostic assessment for detecting common mental health disorders in children attending neurology clinics. The assessment does not require intervention by a mental health professional or additional time in the clinic appointment.SettingTwo parallel and related screening studies were undertaken: Study 1: Tertiary paediatric neurology clinics. Study 2: Secondary and tertiary paediatric neurology clinics.PatientsStudy 1: 406 Young people aged 7–18 attending paediatric neurology clinics. Study 2: 225 Young people aged 3–18 attending paediatric epilepsy clinics.InterventionsParents completed online versions of the Strengths and Difficulties Questionnaire (SDQ) and Development and Well-being Assessment (DAWBA).Main outcome measuresWe investigated: the willingness of families to complete the measures, proportion identified as having mental health disorders, time taken to complete the measures and acceptability to families and clinicians.ResultsThe mean total difficulties score of those that had completed the SDQ fell in the ‘high’ and ‘very high’ ranges. 60% and 70% of the DAWBAS completed met criteria for at least one DSM-IV disorder in study 1 and 2 respectively. 98% of the parents reported that the screening methods used were acceptable.

Objective Children with neurological conditions such as epilepsy are at high risk of developing mental health disorders. Guided self-help can be used to increase access to psychological therapies. When developing and evaluating interventions, it is important to obtain the views of service-users about their acceptability. A telephone-guided self-help intervention was used to treat common mental health difficulties in children and young people with neurological conditions. The intervention was not adapted in content to account for chronic illness. This study therefore reports on qualitative interviews with participants to determine the acceptability of the intervention. Methods Semi-structured interviews were conducted with 27 participants (25 parents and 2 young people) who had undertaken a telephone-delivered guided self-help intervention for common mental health difficulties in the context of a paediatric neurological condition. Transcripts were analysed thematically using the framework approach. Results Thirteen themes were extracted, organised into three main domains, which covered: the practicalities of telephone guided self-help treatment; the outcomes of the intervention; and the extent to which adaptation was needed for chronic illness. Most families found the intervention helpful in working towards their specific goals and noticed changes for the child and/or parents and family. Conclusions Participants had a positive experience of the intervention and the majority of parents found the standard intervention with individualised goals sufficient to meet the young person's mental health needs.

Background Mental contamination, the experience of feeling dirty in the absence of physical uncleanliness, is closely associated with obsessive compulsive disorder (OCD). Given that many features of OCD are found in other diagnoses, the primary aim of this study was to determine whether mental contamination is specific to OCD or whether it is also associated with psychopathology found in other disorders. We hypothesised that, in addition to OCD symptoms, mental contamination would be associated with other psychopathology, in particular symptoms of depression, anxiety and eating disorders, and with transdiagnostic processes such as perfectionism. Methods 120 participants (82%) completed measures of psychological disorders and transdiagnostic processes. Results were analysed using Pearson's r correlations and a multiple regression analysis. Results Mental contamination was most strongly associated with symptoms of OCD but was also associated with eating disorder symptoms, depression and anxiety. It was also correlated with perfectionism, intolerance of uncertainty and fear of compassion. OCD, eating disorder symptoms, fear of compassion and low self-esteem were significant independent predictors of mental contamination. Conclusions Mental contamination is associated with a range of psychopathology but is most strongly associated with symptoms of OCD. Further research is warranted to advance treatment for mental contamination.

Mental contamination is defined and the main features of the phenomenon are set out. In addition to the familiar form of abnormal mental contamination, as evident in psychological disorders, notably Obsessive-compulsive Disorder, the phenomenon of non-clinical mental contamination is common. The clinical form is distressing, uncontrollable, constant and dysfunctional. The normal phenomenon can be disturbing but it is usually dormant, evoked intermittently, transient, tolerable, manageable, not dysfunctional and psychologically fascinating. The cognitive theory of mental contamination encompasses the causes of mental contamination, its persistence, and individual vulnerability. The field would benefit greatly from additional work, such as that reported elsewhere in this Special Issue, to incorporate the unusual manifestations of visual contamination, morphing and self-contamination, and to account for the experience of mental contamination in nonclinical and other clinical manifestations.

Context This review summarizes the current randomized controlled trials literature on psychological and physical outcomes of psychosocial interventions in pediatric oncology. Objectives The objective of this study was to evaluate the effectiveness and impact of psychosocial interventions in children with cancer. Methods A search of the literature resulted in a total of 12 randomized clinical trials and these have evaluated psychosocial interventions in children younger than 18 years with current and previous diagnoses of cancer. Outcome measures were both psychological (e.g., symptoms of anxiety, depression, quality of life, and self-esteem) and physical (e.g., cancer symptoms, treatment adherence, and pain). Interventions identified included cognitive behavioral therapy (CBT; n = 4), joint CBT and physical exercise therapy ( n = 1), family therapy ( n = 2), therapeutic music video ( n = 2), self-coping strategies ( n = 1), a wish fulfillment intervention ( n = 1), and joint family therapy and CBT ( n = 1). Results Nine studies reported statistically significant improvements on psychological outcomes. These findings suggest that psychosocial interventions are effective at reducing anxiety and depressive symptoms as well as improving quality of life. Additionally, six studies found psychosocial interventions to have a positive impact on physical symptoms and well-being, including a reduction in procedural pain and symptom distress. Conclusion These findings suggest that mental health needs in pediatric oncology patients can and should be addressed, potentially which will lead to better mental and physical health outcomes.

Background If left untreated, obsessive compulsive disorder (OCD) can cause significant distress and impact on functioning throughout the lifespan. Despite the severity of the disorder, there is often a significant delay between the onset of symptoms and successful treatment. This is in part due to delays in recognising OCD symptoms in young people, particularly if the symptom forms are less common. Once OCD is accurately diagnosed, cognitive behavioural therapy (CBT) is known to be an efficacious treatment, sometimes in combination with medication, producing good long-term prognosis. It is therefore important to accurately detect OCD in children and young people so that they can be offered timely intervention. Use of the best tools in clinical and research settings improves detection and diagnosis, as well as enabling the tracking of progress through treatment. The aim of this current paper was to review measurement tools for OCD in young people with a focus on the practicalities of using tools in busy child mental health clinical settings. Method To discover what measurement tools are available for OCD in young people, we conducted a pragmatic literature of measurement tools for OCD in young people. We searched PsycINFO, Med-Line and the Cochrane databases for reports relating to the measurement of OCD. Additionally, we sought information from the National Institute for Health and Care Excellence (NICE) guidance, the Child Outcomes Research Consortium (CORC) website and the Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) Programme. We also reviewed large trials and meta-analyses of the treatment of OCD in young people and communicated with relevant researchers/clinicians. Results Seventeen questionnaire measurement tools, with variable psychometric properties, and four commonly used semistructured clinician administered interview measures were identified. Conclusions There are several measurement tools with good psychometric properties that are useful for initial screening/identification of OCD, as well as formal diagnosis, symptom tracking and treatment evaluation. With the availability of brief screens, as well as online diagnostic measures, such tools should not be a burden on clinical practice, but rather a helpful aid to support clinicians' assessment and treatment of OCD.

ObjectiveThis study aimed to conduct a randomised pilot trial to assess the feasibility of a randomised controlled trial (RCT) to investigate the effect of telephone-guided self-help for the treatment of mental health difficulties in children with neurological conditions.DesignPreliminary RCT. The primary outcome measure was the Strengths and Difficulties Questionnaire.SettingNeurology clinics in a national tertiary paediatric hospital.PatientsYoung people attending neurology clinics who met criteria for mental health difficulties according to the Development and Wellbeing Assessment.Interventions12 weeks of telephone-guided self-help based on a modular approach to psychological therapy for children delivered to children and/or their parents (n=17; eight males; mean age 12.04 years, SD=3.34) or a waiting list for telephone-guided self-help with no additional intervention over 12 weeks (n=17; nine males; mean age 10.53 years, SD=3.14).Results124 participants completed the DAWBA, and 34 children and young people were entered into the trial. 65% of those randomised to the intervention arm completed the full intervention, and the intervention was acceptable to those completing it. However, there were significant problems related to lack of data completion (38% data loss for primary outcome measure), choice of control comparator and outcome measures. Due to significant loss of data at follow-up, the effect size findings are considered unreliable.ConclusionsFurther feasibility work should be conducted to improve data completeness before progression to a definitive trial of guided self-help for mental health problems in children with neurological conditions can be recommended.Trial registration numberISRCTN21184717.

Background Mental and physical health treatment should be delivered together for children and young people with epilepsy. Training healthcare professionals (HCPs) in epilepsy services to deliver mental health interventions is an important way to facilitate integrated care. Objective To determine the feasibility of remotely delivered assessment and psychological treatment for mental health difficulties delivered by HCPs in pediatric epilepsy clinics with limited formal training in psychological interventions. We hypothesized that it would be (i) feasible to train HCPs to deliver the psychological intervention and (ii) that participants receiving the psychological therapy would report reductions in symptoms of mental health difficulties including anxiety, depression, and behavior difficulties and improve quality of life. Methods Thirty-four children and young people with epilepsy who had impairing symptoms of a common mental health difficulty (anxiety, depression, disruptive behavior, and/or trauma) were allocated to receive 6 months of a modular cognitive behavioral intervention delivered by a HCP with limited formal psychological therapy experience. Thirteen HCPs were trained in delivery of the intervention. Healthcare professional competence was assessed in a two-stage process. Parent-reported measures of mental health symptoms and quality of life were completed at baseline and following the intervention. Paired t-tests were used to analyze changes in symptoms over time. Results All thirteen HCPs who participated in the training were considered competent in therapeutic delivery by the end of the training period. Twenty-three patients completed pre- and post-intervention measures and were included in the analysis. There were statistically significant improvements in: symptoms of mental health problems (p = 0.01; Cohen’s d = 0.62), total impact of mental health problems (p = 0.03; Cohen’s d = 0.52), anxiety and depression symptoms (p = 0.02; Cohen’s d = 0.57) and quality of life (p = 0.01; Cohen’s d = 0.57). Conclusion A modular cognitive behavioral treatment delivered over the telephone by HCPs with limited experience of psychological therapy was feasible and effective in treating mental health problems in children and young people with epilepsy. Health-related Quality of Life also improved over the duration of treatment. A randomized controlled trial (RCT) is needed to demonstrate efficacy of the intervention.

Perfectionism can present as a clinical problem in its own right or it can interfere with the successful treatment of Axis I disorders. In the past 15 years, a cognitive behavioral analysis of “clinical perfectionism” has been proposed. This approach and the measurement of the construct of clinical perfectionism have proved controversial. Nevertheless, the approach has experimental support and clinical utility; the derived treatment has been shown to lead to significant improvement on both measures of perfectionism and Axis I disorders. The cognitive behavioral intervention for perfectionism has been evaluated in a range of formats (group, individual, face-to-face, and online) and all show promise. Further work is required to address clinically important questions such as when to treat clinical perfectionism if it occurs in the context of single and multiple Axis I disorders.

Rates of psychiatric disorders are considerably elevated in young people with long term physical health conditions. Currently few children obtain effective mental health treatments in the context of long term physical health conditions, and ways to improve access to evidence-based mental health interventions are urgently needed. One approach is to deploy briefer, more economical, yet still evidence-based, treatments. The objective of this review was to evaluate the efficacy of brief interventions targeting psychiatric disorders in children and young people with long term physical health conditions.Predefined terms relating to brief psychological interventions for psychiatric disorders in children with long term physical health conditions were used to search relevant databases. A systematic review and meta-analysis was carried out in accordance with the Cochrane guidelines. Two reviewers independently screened titles and abstracts, extracted the data and conducted risk of bias assessments.A total of 12 randomised controlled trials were found to meet the inclusion criteria of the review. Of those, three studies were suitable for meta-analysis. A large effect size in favour of brief cognitive behavioural therapy for anxiety was found (g = - 0.95, CI -1.49 to -0.041; p .001) with non-significant moderate-substantial heterogeneity (IThis review suggests there is preliminary evidence that brief interventions, based on cognitive behavioural principles, may benefit young people with an anxiety disorder in the context of a long term physical health condition. There was insufficient evidence to assess whether this held true for depression and disruptive behaviour.

Mental health problems are common in children and adolescents, yet evidence-based treatments are hard to access. Self-help interventions can increase such access. The aim of this paper was to conduct a systematic review and meta-analysis of the use of guided and unguided self-help for children and young people with symptoms of common mental health disorders. In contrast to previous reviews of self-help in children, all types of self-help and multiple mental health disorders were investigated in order to increase power to investigate potential moderators of efficacy. Importantly, studies with control arms as well as those comparing against traditional face-to-face treatments were included. Fifty studies (n = 3396 participants in self-help/guided self-help conditions) met the inclusion criteria. Results demonstrated a moderate positive effect size for guided and unguided self-help interventions when compared against a control group (n = 44; g = 0.49; 95% CI: 0.37 to 0.61, p

Background Anxiety and depression are closely associated. However, they are typically treated separately and there is a dearth of information on tackling them together. Aims The study's purpose was to establish how best to treat co-occurring anxiety and depression in a routine clinical service-specifically, to compare cognitive behaviour therapy (CBT) focusing only on depression (CBT-D) to a broader CBT focusing on both depression and anxiety (CBT-DA). Method Case notes of 69 patients with equally severe clinical levels of depression and anxiety seen in a routine clinical service were randomly selected to review from a pool of 990 patients. The mean age was 44.61 years (SD = 12.97). 65% of the sample were female and 88% reported their ethnicity white. The content of electronic records reporting techniques used and scores on a measure of depression (The Patient Health Questionnaire) and anxiety (The Generalized Anxiety Disorder Assessment) were reviewed to categorise therapy as CBT-D or CBT-DA. Results Results indicated significant overall improvement with CBT; 70% and 77% of the sample met criteria for reliable improvement on The Patient Health Questionnaire and The Generalized Anxiety Disorder Assessment respectively. Fewer patients who received CBT-DA met The Generalized Anxiety Disorder Assessment recovery criteria at the end of treatment than those who received CBT-D. Mean post treatment PHQ-9 and GAD-7 scores remained above threshold for those receiving CBT_DA but not those receiving CBT-D. There was no evidence suggesting CBT-DA was superior to CBT-D. Conclusions In patients with equally severe clinical levels of depression and anxiety, a broader treatment addressing both anxiety and depression does not appear to be associated with improved outcomes compared to treatment focused on depression.

Background Children and young people with chronic neurological conditions have significantly higher rates of mental health disorders than those without a chronic health condition, or those with chronic illnesses that do not involve the CNS. Mental health problems can impact on quality of life as well as on the management and medical consequences of the physical illness yet may be relatively easy to treat. However, such mental health disorders often go unrecognised and therefore untreated. The aim of the current study was to establish the feasibility of routine screening and brief telephone intervention for mental health disorders in paediatric neurology clinics. Methods Parents of children and young people aged 7–18 attending specialist paediatric neurology clinics were asked to complete an online screening questionnaire (the Strengths and Difficulties Questionnaire; SDQ) on a tablet computer in clinic. Those who had symptoms of a mental health disorder were invited to complete a longer online diagnostic questionnaire, the Development and Wellbeing Assessment (DAWBA), at home. Those with impairing symptoms were offered a 10-session guided self-help intervention delivered over the telephone. Standardised measures were completed before, during and after the intervention. Results The method of identification proved feasible in terms of numbers completing the SDQ (n=406, of which n=232 had significant symptoms of a mental health disorder) and DAWBA (n=124). 76% of those completing the DAWBA met DSM-V diagnostic criteria for a mental health disorder. 40 families took part in the brief intervention and results are promising, with progress made towards families chosen goals and high levels of satisfaction reported by families and clinicians. Conclusions Children and young people with chronic neurological conditions have high rates of mental health disorders. These disorders can be detected and treated through a simple online diagnostic tool and telephone intervention and this method is acceptable to families.

PurposeTo determine the incidence of medically unexplained visual loss (MUVL) in children in an open access children's eye casualty.Patients and methodsWe collated demographic and clinical data of consecutive patients younger than 16 years who presented to the children's eye casualty at Moorfields Eye Hospital over a 12-month period and were diagnosed with MUVL or suspected MUVL. We reviewed the clinical records at least 3 months after initial presentation. We calculated the incidence using the number of 'new patient' attendances over the same period as denominator (n=2397). We used descriptive analysis.number of patients diagnosed with MUVL, proportion of patients with a history of or present psychological problems, recovery rate, and improvement in visual acuity.ResultsWe identified 85 cases of MUVL (54 females; median age: 9 years (IQR 7-12)). The median duration of follow-up was 1.2 months (IQR 0-4.3). The estimated annual incidence was 3.5% (95% confidence interval 2.9-4.4%). Thirty-three per cent of children had a history of psychiatric disorders, reported a stressful life event, or showed signs of psychiatric disorder at the time of first presentation. The recovery rate was 25%. Median improvement in best-corrected visual acuity from presentation to last appointment was 0.22 (IQR 0.06-0.43) logMAR.ConclusionThe incidence of MUVL is higher and the rate of resolution lower than previously reported. MUVL may be associated with mental health problems. We recommend screening for psychological problems to facilitate access to psychological treatment.

Objectives The telephone is increasingly used to deliver psychological therapies for common mental health problems. This review addressed the following question: are evidence-based psychological therapies for adults with depression and/or anxiety effective in reducing psychological symptoms when delivered over the telephone? Method A systematic search for articles published over a 25-year period (January 1991–May 2016) was performed using the databases PsycINFO, PubMed and Web of Science. Citation searches, manual searches of bibliographies of relevant papers, and hand searches of key journals were also conducted. The quality of the studies included for review was assessed using the Effective Public Health Practice Project Quality Assessment Tool. Results Fourteen studies met inclusion criteria for the review. Ten reported findings from telephone treatment for depression and four for anxiety. Nine studies used randomised controlled designs, two used quasi-experimental designs and three used uncontrolled designs. Thirteen studies reported reductions in symptoms of depression or anxiety. Cohen’s d ranged from 0.25–1.98 (median = 0.61) for controlled studies and from 1.13–1.90 (median = 1.26) for uncontrolled studies. Only four studies reported clinically significant change. Conclusions The findings indicate that telephone-delivered interventions show promise in reducing symptoms of depression and anxiety. Further research is required to establish the types of interventions that are most effective and the characteristics of clients who find them beneficial.

People with epilepsy are significantly more likely to have a mental health disorder than those without a chronic illness. The reasons for this are multiple but may include the mental health difficulties being perceived as complex due to the presence of a chronic illness. In part due to the apparent complexity of the co-occurring physical and mental illness, many are not offered evidence-based treatment (EBT) for the mental health disorder. There is little guidance to inform clinicians about the interventions to use to treat mental health disorders in people with epilepsy. The present paper reports a case of treatment for depression using a standard EBT in a young person with epilepsy. The patient also had clinically significant symptoms of anxiety and an eating disorder and would be considered ‘complex’ according to standard criteria. The intervention, however, was relatively simple and was delivered as guided self-help via 10 weekly telephone calls of approximately 30 minutes duration, and two follow-up calls at one month and three months post-intervention. Self-report and parent-report questionnaire measures were completed before and after the intervention, and at both follow-up time points. A blind-rated online diagnostic interview measure was also completed before and after the intervention. The young person and her family also completed a qualitative interview of their experiences of the intervention. This simple intervention was effective in working towards the client's goals, although pre–post measurement on standard measures was variable. This interesting case raises questions about whether patients with mental and physical comorbidities are complex, or just perceived as complex.

There has been a recent expansion of interest in the concept of mental contamination. Despite a growing number of experiments and interview-based studies of mental contamination, there is a need for questionnaire-based assessment measures, and for a further understanding of the degree to which mental contamination is related to other aspects of OCD symptomatology and/or to established cognitive constructs relevant to OCD. We assessed the psychometric properties of three new measures of mental contamination (the Vancouver Obsessional Compulsive Inventory – Mental Contamination Scale, the Contamination Sensitivity Scale, and the Contamination Thought-Action Fusion Scale) in participants diagnosed with OCD (n = 57), participants diagnosed with an anxiety disorder other than OCD (n = 24) and in undergraduate student controls (n = 410). For some of these analyses, our OCD sample was subdivided into those with contamination-related symptoms and concerns (n = 30) and those whose OCD excluded concerns related to contamination fear (n = 27). Results showed that the three new scales had excellent psychometric properties, including internal consistency, convergent and divergent validity, and discriminant validity. Further, the new measures accounted for significant unique variance in OCD symptoms over and above that accounted for by depression, anxiety, traditional contact-based contamination, and OCD beliefs. Results are discussed in terms of the clinical utility of the scales, and of the nature of contamination fears in OCD.

Background and objectives Fear of contamination can be evoked following physical contact with a dirty, harmful or polluted item, person, or place (contact contamination) or in the absence of physical contact with a contaminant (mental contamination). The spread of contact contamination does not degrade over successive degrees of removal from the contaminated source. However, to date, the spread of mental contamination has not been empirically investigated. This study aimed to examine the spread and degradation of mental contamination. Methods The paradigm of Tolin et al. (2004) was adapted. Feelings of mental contamination were evoked, and participants were asked to transfer these feelings to an uncontaminated pencil by touching it (contact condition) and without touching it (no contact condition). Results Seventy-two percent of participants in the contact condition and 48% participants in the no-contact condition reported being able to transfer contamination to a clean pencil, demonstrating that mental contamination transfers both with and without contact. In both conditions, the mental contamination subsequently spread to a series of 12 neutral pencils without degradation. Conclusions These findings suggest that mental contamination can be transmitted and spread in the absence of physical contact, similar to contact contamination.

Background and objectives It has recently been identified that feelings of contamination can arise in the absence of physical contact with a stimulus. This concept, known as ‘mental contamination’ has particular relevance to Obsessive Compulsive Disorder in which compulsive cleaning is a common symptom presentation. Experimental studies have begun to examine the psychopathology of mental contamination. The aims of the two experiments reported here were to explore the evocation and spontaneous decay of mental contamination. Methods In Experiment 1, a variant of the autobiographical memory task was used in which 40 non-clinical participants were asked to recall autobiographical memories associated with betrayal, harm, humiliation and violation of moral standards. In Experiment 2, 60 participants with moderate levels of mental contamination were asked to complete five short tasks designed to induce mental contamination, including recalling unwanted memories and images. Results In both experiments, participants reported significant increases in mental contamination, anxiety, urges to wash and actual washing behaviour. In experiment 1, the effect of the induction decayed spontaneously. Experiment 2 found that re-evoking contamination and repeated washing led to the persistence of mental contamination. Limitations The studies were conducted on non-clinical samples. Conclusions These findings demonstrated that repeated triggers may be causally connected to the maintenance of mental contamination fears in non-clinical samples.

Objectives Intrusive imagery is hypothesised to evoke feelings of contamination and urges to wash. This study aimed to (1) develop a questionnaire to assess imagery associated with contamination fears; and (2) compare contamination imagery in a sample of people with contamination based obsessive–compulsive disorder (C-OCD) with a non-clinical student sample. Methods Non-clinical students ( n =45) and people with C-OCD and contamination fears ( n =45) completed a self-report questionnaire designed to assess images associated with contamination. Results Compared to non-clinical participants, people with C-OCD reported images associated with contamination that were more vivid, harder to dismiss and distressing. Participants with contamination fears reported images that directly evoked feelings of dirtiness and triggered compulsive washing behaviours. A small number of participants reported beneficial images that reduced feelings of contamination. Conclusions These preliminary findings indicate that imagery can evoke feelings of contamination. However, future research is needed to establish the nature and causative role of imagery in mental contamination. Questionnaire methods may be useful for clinical assessment of imagery associated with contamination fears.

Experimental evidence using picture–word cues has shown that generating mental imagery has a causal impact on emotion, at least for images prompted by negative or benign stimuli. It remains unclear whether this finding extends to overtly positive stimuli and whether generating positive imagery can increase positive affect in people with dysphoria. Dysphoric participants were assigned to one of three conditions, and given instructions to generate mental images in response to picture–word cues which were either positive, negative or mixed (control) in valence. Results showed that the positive picture–word condition increased positive affect more than the control and negative conditions. Participants in the positive condition also demonstrated enhanced performance on a behavioural task compared to the two other conditions. Compared to participants in the negative condition, participants in the positive condition provided more positive responses on a homophone task administered after 24 h to assess the durability of effects. These findings suggest that a positive picture–word task used to evoke mental imagery leads to improvements in positive mood, with transfer to later performance. Understanding the mechanisms underlying mood change in dysphoria may hold implications for both theory and treatment development., Highlights ► A mental imagery generation task was tested on a sample of dysphoric participants. ► We examined changes in depressed mood, behaviour and cognitive bias. ► Positive, negative and mixed valence (control) imagery conditions were contrasted. ► Positive imagery led to an improvement in mood and behaviour.

Background: It was recently proposed that feelings of dirtiness and pollution can arise in the absence of physical contact with a contaminant. At present, there is limited data regarding the qualitative features of this construct of “mental contamination”, although it is hypothesized to be particularly relevant to Obsessive Compulsive Disorder (OCD), where compulsive washing in response to contamination fear is a common symptom presentation (Rachman, 2006). Aims and method: The aim of this research was to explore the qualitative features of mental contamination in 20 people with contamination-based OCD, using a semi-structured interview. Results: All participants reported times when they had felt dirty or contaminated in the absence of physical contact with a dirty or dangerous object. Mental contamination generated diffuse feelings of internal dirtiness not localized to the hands, which evoked urges to wash (100% participants), neutralize (80% participants) and avoid (85% participants). Conclusions: In support of the theory outlined by Rachman (2006), mental contamination was found to take a number of forms, be primarily associated with a human source, generate internal dirtiness and cause emotional distress and urge to wash. The clinical implications of these findings are discussed and ideas for future research are proposed.

Perfectionism is a transdiagnostic construct associated with a range of diagnoses, including depression, eating disorders and obsessive compulsive disorder. Treatments that directly target perfectionist cognitions have been shown to successfully reduce associated pathologies. However, the way in which they do this is not clear. We set out to assess the role of one candidate mechanism of action, namely the cognitive process of interpretation of ambiguity. In one experiment we looked for associations between biased interpretation and perfectionism. In a second, we manipulated interpretations, thereby providing a strong test of their aetiological significance. Results from the first experiment confirmed the presence of biased interpretation in perfectionism and demonstrated that these are highly specific to perfection relevant information, rather than reflecting general negativity. The second experiment succeeded in manipulating these perfection relevant interpretations and demonstrated that one consequence of doing so is a change in perfectionist behaviour. Together, these data experimentally demonstrate that biased interpretation of perfection relevant ambiguity contributes to the maintenance of perfectionism, but that it is also possible to reverse this. Clinical implications include the identification of one likely mechanism of therapeutic change within existing treatments, as well as identification of an appropriate evidence-based focus for future treatment development. Targeting underlying functional mechanisms, such as biased interpretation, has the potential to offer transdiagnostic benefits.