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Abstract Background Access to psychotherapy is limited by psychopathology (e.g. agoraphobia), physical disability, occupational or social constraints and/or residency in under-served areas. For these populations, interventions delivered via remote communication technologies (e.g. telephone, internet) may be more appropriate. However, there are concerns that such delivery may influence the therapeutic relationship and thus reduce therapy effectiveness. This review aimed to determine the clinical effectiveness of remotely communicated, therapist-delivered psychotherapy. Methods Systematic review (including electronic database searching and correspondence with authors) of randomised trials of individual remote psychotherapy. Electronic databases searched included MEDLINE (1966–2006), PsycInfo (1967–2006), EMBASE (1980–2006) and CINAHL databases (1982–2006). The Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDAN-CTR). All searches were conducted to include studies with a publication date to July 2006. Results Thirteen studies were identified, ten assessing psychotherapy by telephone, two by internet and one by videoconference. Pooled effect sizes for remote therapy versus control conditions were 0.44 for depression (95%CI 0.29 to 0.59, 7 comparisons, n = 726) and 1.15 for anxiety-related disorders (95%CI 0.81 to 1.49, 3 comparisons, n = 168). There were few comparisons of remote versus face-to-face psychotherapy. Conclusion Remote therapy has the potential to overcome some of the barriers to conventional psychological therapy services. Telephone-based interventions are a particularly popular research focus and as a means of therapeutic communication may confer specific advantages in terms of their widespread availability and ease of operation. However, the available evidence is limited in quantity and quality. More rigorous trials are required to confirm these preliminary estimates of effectiveness. Future research priorities should include overcoming the methodological shortcomings of published work by conducting large-scale trials that incorporate both clinical outcome and more process-orientated measures.

Background: Cognitive behavioural treatments are recommended for people with psychosis. Core beliefs regarding the self and others are a key part of the models underpinning cognitive behavioural therapy but detailed understanding of these putative beliefs in people with psychosis are limited. A greater understanding of these mechanisms is necessary to improve and refine treatments. Aims: This study utilized a qualitative approach to explore core schematic beliefs in psychosis (strongly held positive and negative beliefs about the self and others) and their relation to hallucinations and delusions. Method : Twenty individuals with psychosis participated in individual semi-structured interviews. Inductive thematic analysis was used to analyse the interviews. Results : Four emergent themes were identified: (i) the solidity and permanency of core beliefs, (ii) the causes and development of core beliefs, (iii) a synergistic relationship between core beliefs and symptoms, and (iv) core beliefs associated with images and their influence on psychotic symptoms. Conclusions : This study provides new insights into the range and character of core beliefs in psychosis and provides important data to guide ongoing and future development of treatment approaches for psychosis. [ABSTRACT FROM AUTHOR]

Intrusive mental imagery and negative beliefs about self and others are frequently reported problems for individuals who experience psychosis, but there are few treatment approaches that have specifically targeted these. Intrusive mental images and negative schema have been identified as potential maintaining factors for persecutory delusions. These can range from paranoia-related recurrent intrusive images (e.g., being attacked by others, being followed by unknown figures who mean you harm) from the past or "flash-forward" future paranoia related intrusive mental images. In this article we outline clinical issues and adaptations of an imagery-focused approach for persecutory delusions. Drawing on a number of sources including a systematic literature review, a qualitative study exploring core beliefs, an experience sampling study and techniques from existing manuals and approaches, we adapted these imagery approaches to work with images and schema. The close links between imagery and core beliefs highlighted an opportunity to also use imagery rescripting approaches to transform negative schema and reduce persecutory delusions. Individuals with psychosis often want help with intrusive mental images and negative beliefs; adapted evidence-based imagery focused interventions can be used and the interventions may also help to reduce persecutory delusions. • First description of imagery rescripting treatment approach for persecutory delusions in psychosis • Detailed session-by-session guide and examples of approach • Key challenges and ways these can be overcome are discussed [ABSTRACT FROM AUTHOR]