Cognitive Behaviour Therapy

Objective: Although the clinical efficacy of cognitive behaviour therapy (CBT) has been established for patients with schizophrenia, the data on effects on quality of life (QoL) are lacking. The purpose of the present study was therefore to compare the effects of a brief group CBT and a group psychoeducational (PE) programme in patients with schizophrenia on QoL. Method: A total of 88 inpatients with schizophrenia were randomized to receive a therapy envelope of 8 weeks including either 16 sessions of group CBT or eight sessions of group PE treatment. QoL was assessed using the Modular System for Quality of Life at baseline, post-treatment assessment and 6 month follow up. Results: QoL improved signifi cantly in both treatments in most QoL dimensions. Withingroup effect sizes for general QoL at follow up were 0.25 for CBT and 0.29 for PE. No signifi cant differences between CBT and PE were found at post-treatment and at 6 month follow up. Conclusions: Both brief group CBT and group PE improve subjective QoL in patients with schizophrenia.

Objective: To determine whether cognitive behaviour therapy is an effective treatment for childhood and adolescent depressive disorder. Design: Systematic review of six randomised trials comparing the efficacy of cognitive behaviour therapy with inactive interventions in subjects aged 8 to 19 years with depressive disorder. Main outcome measure: Remission from depressive disorder. Results: The rate of remission from depressive disorder was higher in the therapy group (129/208; 62%) than in the comparison group (61/168; 36%). The pooled odds ratio was 3.2 (95% confidence interval 1.9 to 5.2), suggesting a significant benefit of active treatment. Most studies, however, were based on relatively mild cases of depression and were of only moderate quality. Conclusions: Cognitive behaviour therapy may be of benefit for depressive disorder of moderate severity in children and adolescents. It cannot, however, yet be recommended for severe depression. Definitive large trials will be required to determine whether the results of this systematic review are reliable.

We randomly assigned 40 Union Council clusters in rural Rawalpindi, Pakistan, in equal numbers to intervention or control. Married women (aged 16–45 years) in their third trimester of pregnancy with perinatal depression were eligible to participate. In the intervention group, primary ...

Objective: To provide a summary of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guideline for the Management of Anorexia Nervosa (AN). Conclusions: Anorexia nervosa affects only a small proportion of the Australian and New Zealand population but it is important because it is a serious and potentially life-threatening illness. Sufferers often struggle with AN for many years, if not for life, and the damage done to their minds and bodies may be irreversible. Anorexia nervosa is characterized by a deliberate loss of weight and refusal to eat. Overactivity is common. Approximately 50% of patients also use unhealthy purging and vomiting behaviours to lose weight. There are two main areas of physical interest: the undernutrition and mal-nutrition of the illness and the various detrimental weight-losing behaviours themselves. Basic psychopathology ranges from an over-valued idea of high salience concerning body shape through to total preoccupatio...

The literature suggests that cancer survivors with more aggressive treatments are more at risk for postcancer fatigue. In this study, we investigated the prevalence of fatigue after completion of stem cell transplantation (SCT). Furthermore, we studied if medical variables are associated with fatigue and if the model of perpetuating factors of postcancer fatigue derived from previous studies in cancer survivors, without SCT, is applicable in SCT survivors. Ninety-eight patients treated with autologous or allogeneic SCT filled out several questionnaires. Medical characteristics were obtained from the medical charts. All patients had to be in persistent complete remission for at least 1 year. Thirty-five per cent of the patients experienced severe fatigue. The percentage of patients with severe fatigue remained stable during the years after transplantation. Several psychosocial factors, but no medical factors, were associated with fatigue. The model of perpetuating factors appeared to be applicable. Contrary to cancer survivors without SCT, we found no decrease in fatigue complaints during the first years after SCT. Cognitive behaviour therapy (CBT) is a general form of psychotherapy directed at changing conditionrelated cognitions and behaviours. CBT especially designed for postcancer fatigue, aimed at perpetuating factors, can also be used to manage fatigue in cancer survivors treated with SCT.

To investigate (i) the differential changes in premenstrual symptoms, mood, cognitions, and coping strategies during two treatments [cognitive-behavioural therapy (CBT) and fluoxetine] for premenstrual dysphoric disorder (PMDD) and (ii) the characteristics of those with good vs. poor outcome post treatment and at 1 year follow-up. Premenstrual symptoms, mood (Hospital Anxiety and Depression Scale, HADS), causal attributions, and use of cognitive and behavioural coping strategies were examined during 6 months of both treatments. The two treatment groups were then combined and divided on the basis of good vs. poor outcome posttreatment and at 1 year follow-up. Baseline measures were used to predict posttreatment outcome, and baseline and posttreatment measures were examined when attempting to predict outcome at 1 year follow-up. Both treatments were equally effective at the end of 6 months (prospective daily diary measure). Fluoxetine treatment had a more rapid effect and greater impa...

To determine which factors impact on the efficacy of cognitive behavioural therapy (CBT) for depression and anxiety. Factors considered include those related to clinical practice: disorder, treatment type, duration and intensity of treatment, mode of therapy, type and training of therapist and severity of patients. Factors related to the conduct of the trial were also considered, including: year of study, country of study, type of control group, language, number of patients and percentage of dropouts from the trial. Method: We used the technique of meta-analysis to determine an overall effect size (standardized mean difference calculated using Hedges' g) and meta-regression to determine the factors that impact on this effect size. We included randomized controlled trials with a wait list, pill placebo or attention/psychological placebo control group. Study participants had to be 18 years or older and all have diagnosed depression, panic disorder (with or without agoraphobia) or generalized anxiety disorder (GAD). Outcomes of interest included symptom, functioning and health-related quality of life measures, reported as continuous variables at post-treatment. Results: Cognitive behavioural therapy for depression, panic disorder and GAD had an effect size of 0.68 (95% CI = 0.51-0.84, n = 33 studies, 52 comparisons). The heterogeneity in the effect sizes was fully explained by treatment, duration of therapy, inclusion of severe patients in the trial, year of study, country of study, control group, language and number of dropouts from the control group. Disorder was not a significant predictor of the effect size. Conclusions: Cognitive behavioural therapy is significantly less effective for severe patients and trials that compared CBT to a wait-list control group found significantly larger effect sizes than those comparing CBT to an attention placebo, but not to a pill placebo. Further research is needed to determine whether CBT is effective when provided by others than psychologists and whether it is effective for non-English-speaking patient groups.

In the present study, we examined the effect of an internet cognitive behavior therapy (ICBT) program on anxiety, stress, and depressive symptoms in university students. Data were analyzed for 17 participants undergoing ICBT and 11 control group participants. An ANOVA of intention-to-treat analysis and per protocol (PP) analysis indicated that the interaction between group and measurement time was significant for the state-trait anxiety inventory (STAI) scores and that idiosyncratic anxiety was significantly improved. Through the results of PP, a moderate effect size for changes in STAI scores in the intervention group was observed (d = 0.62) based on Cohen's (1988) classifications. A large effect was also observed for improvements in idiosyncratic anxiety (d = 0.91). Based on the results of the analyses, a significant interaction was observed for the STAI scores. In the intervention group, STAI scores and individual anxiety were significantly reduced after implementing the ICBT program. It was suggested that the ICBT program may positively influence thinking about anxiety and stress from an objective viewpoint.

Objective: The study examined the relative efficacy of online (NET) versus clinic (CLIN) delivery of
cognitive behavior therapy (CBT) in the treatment of anxiety disorders in adolescents. Method: Participants
included 115 clinically anxious adolescents aged 12 to 18 years and their parent(s). Adolescents
were randomly assigned to NET, CLIN, or wait list control (WLC) conditions. The treatment groups
received equivalent CBT content. Clinical diagnostic interviews and questionnaire assessments were
completed 12 weeks after baseline and at 6- and 12-month follow-ups. Results: Assessment at 12 weeks
post-baseline showed significantly greater reductions in anxiety diagnoses and anxiety symptoms for
both NET and CLIN conditions compared with the WLC. These improvements were maintained or
further enhanced for both conditions, with minimal differences between them, at 6- and 12-month
follow-ups. Seventy-eight percent of adolescents in the NET group (completer sample) no longer met
criteria for the principal anxiety diagnosis at 12-month follow-up compared with 80.6% in the CLIN
group. Ratings of treatment credibility from both parents and adolescents were high for NET and
equivalent to CLIN. Satisfaction ratings by adolescents were equivalent for NET and CLIN conditions,
whereas parents indicated slightly higher satisfaction ratings for the CLIN format. Conclusions: Online
delivery of CBT, with minimal therapist support, is equally efficacious as clinic-based, face-to-face
therapy in the treatment of anxiety disorders among adolescents. This approach offers a credible
alternative to clinic-based therapy, with benefits of reduced therapist time and greater accessibility for
families who have difficulty accessing clinic-based CBT.
Keywords: adolescent, anxiety, cognitive behavior therapy, computer, online

Recibido el 4-9-2006; aceptado para su publicación el 21-12-2006. FUNDAMENTO Y OBJETIVO: El objetivo de este estudio es cuantificar la eficacia del tratamiento cognitivo-conductual para la deshabituación tabáquica en el embarazo y objetivar los factores de riesgo de éxito o fracaso para la abstinencia antes del parto. PACIENTES Y MÉTODO: Se estudió a 74 mujeres embarazadas y fumadoras que entre enero de 2003 y enero de 2004 acudieron a su visita de control obstétrico regular en el Hospital Casa Maternitat-Hospital Clínic i Provincial de Barcelona, y que voluntariamente accedieron al tratamiento cognitivo-conductual sin sustitución de nicotina para la deshabituación tabáquica que se les ofreció. RESULTADOS: El 44% de las mujeres que realizaron el programa de visitas llegó abstinente al parto, y de ellas el 93,1% se mantuvo abstinente durante la cuarentena. El 51,5% redujo el consumo y un 4,5% se mantuvo sin cambios o aumentó el consumo. El hecho de que alguien fume en casa (p = 0,006), el grado de dependencia de la nicotina (p = 0,015) y un consumo de café superior a 3 tazas/día (p = 0,039), en una ecuación de regresión logística, separaron los 2 grupos (abstinencia/no abstinencia). CONCLUSIONES: La eficacia de un programa basado en el tratamiento cognitivo-conductual, sin sustitución de nicotina, para la deshabituación tabáquica en el embarazo se ha confirmado en nuestra muestra. Se propone contemplar como factores de riesgo de fracaso en el tratamiento el hecho de que alguien fume en casa y un consumo elevado de café.

The present case study is about a 23 year’s old married man from a middle socioeconomic status Muslim family residing in Islamabad. He came with the signs of obsessive compulsive disorder such as obsessions, compulsions, superstitious thinking with comorbid depression, low mood, somatic complaints, anxiety, nervousness, tension, isolation and hostility. He was having these symptoms since 2006 to 2021. The present case study was conducted to assess the efficacy of cognitive behavior therapy (CBT) for individuals suffering with obsessive compulsive disorder. Case study continued for 12 sessions of cognitive behaviors therapy. 3 (1-3) sessions were conducted in initial phase, 5 sessions (4-9) were conducted in middle phase and 3 (10-12) sessions were conducted in termination phase and 2 follow up sessions after termination phase. Patient’s improvement was started in middle phase of the treatment; he seemed hopeful and motivated in getting better. After the end of the middle phase, he w...

Background: The majority of randomised controlled trials examining the effectiveness of antenatal group interventions at preventing postnatal depression in "at risk" women have used a "psychoeducational" intervention. The aim of the present study is to evaluate the effectiveness of an antenatal cognitive behavioural group intervention in a primary care setting for pregnant women identified with mild to moderate symptoms in pregnancy and/or at risk of developing depression or anxiety in the perinatal period. Method: Subjects were randomised to a CBT group intervention or control condition (information booklet) and administered the EPDS and STAI at pre (Time 1) and post intervention (Time 2), and at 2 months (Time 3) and 4 months postpartum (Time 4). MINIs were administered at Times 1, 3 and 4. Results: Of the 774 women approached, 277 accepted and were suitable; thus 191 were randomised to the CBT intervention and 86 to the control condition. The subsequent 52% drop-out left 89 women "completing" the CBT groups and 43 in the control group; these two groups were well matched on demographic variables. Intention to treat analyses revealed relatively low mean baseline EPDS scores (means 6.88 -8.16) with no reduction in EPDS scores in either group from Time 1 to Time 4. MINI depression criteria were fulfilled by 19% of all participants at Time 1 but there was no reduction in depression in either group; in contrast those with MINI anxiety diagnoses reduced from 28% in late pregnancy to 16% at four months postpartum in the CBT group with similar reductions in the control group. Analyses on the 132 "completers" showed significant symptomatic improvement over time for both the CBT group and control condition. Depression scores in the most symptomatic women (EPDS N 12; N = 19) decreased steadily by over 50% over the total time course but there were no differences in improvement between the CBT and control groups. Limitations: A number of methodological factors may have obscured our results including a tendency to natural remission in mildly symptomatic subjects and the possibility that our control condition was therapeutic in itself.

1,4Virtual Reality Laboratory, EPFL, IC ISIM, Station 14, 1015 Lausanne, SWITZERLAND 2Pychiatrist and psychotherapist, Rue du Valentin 61, 1004 Lausanne, SWITZERLAND 3Computer Science Department, Aalborg University Esbjerg, Niels Bohrs vej 8, 6705 Esbjerg, DENMARK

Background: There are high rates of co-occurring depression among young people with substance use disorders. While there is preliminary evidence for the effectiveness of integrated cognitive behaviour therapy (CBT) in combination with antidepressants among alcohol and substance dependent adolescents and adults with co-existing depression, no studies have examined the effectiveness of integrated CBT interventions in the absence of pharmacotherapy.

Background: Several studies have showed that people with intellectual disabilities (ID) have suitable skills to undergo cognitive behavioural therapy (CBT). Case studies have reported successful use of cognitive behavioural therapy techniques (with adaptations) in people with ID. Modified cognitive behavioural therapy may be a feasible and effective approach for the treatment of depression, anxiety, and other mood disorders in ID. To date, two studies have reported group-based manaulised cognitive behavioural treatment programs for depression in people with mild ID. However, there is no individual manualised programme for anxiety or depression in people with intellectual disabilities. The aims of the study are to determine the feasibility of conducting a randomised controlled trial for CBT in people with ID. The data will inform the power calculation and other aspects of carrying out a definitive randomised controlled trial. Methods: Thirty participants with mild ID will be allocated randomly to either CBT or treatment as usual (TAU). The CBT group will receive up to 20 hourly individual CBT over a period of 4 months. TAU is the standard treatment which is available to any adult with an intellectual disability who is referred to the intellectual disability service (including care management, community support, medical, nursing or social support). Beck Youth Inventories (Beck Anxiety Inventory & Beck Depression Inventory) will be administered at baseline; end of treatment (4 months) and at six months to evaluate the changes in depression and anxiety. Client satisfaction, quality of life and the health economics will be secondary outcomes. Discussion: The broad outcome of the study will be to produce clear guidance for therapists to apply an established psychological intervention and identify how and whether it works with people with intellectual disabilities.

Objectives To investigate the effect of group cognitive behavioural therapy (CBT) for fatigue self-management, compared with groups receiving fatigue information alone, on fatigue impact among people with rheumatoid arthritis (RA). Methods Two-arm, parallel randomised controlled trial in adults with RA, fatigue ≥6/10 (Visual Analogue Scale (VAS) 0-10, high bad) and no recent change in RA medication. Group CBT for fatigue self-management comprised six (weekly) 2 h sessions, and consolidation session (week 14). Control participants received fatigue self-management information in a 1 h didactic group session. Primary outcome at 18 weeks was the impact of fatigue measured using two methods (Multi-dimensional Assessment of Fatigue (MAF) 0-50; VAS 0-10), analysed using intention-to-treat analysis of covariance with multivariable regression models. Results Of 168 participants randomised, 41 withdrew before entry and 127 participated. There were no major baseline differences between the 65 CBT and 62 control participants. At 18 weeks CBT participants reported better scores than control participants for fatigue impact: MAF 28.99 versus 23.99 (adjusted difference −5.48, 95% CI −9.50 to −1.46, p=0.008); VAS 5.99 versus 4.26 (adjusted difference −1.95, 95% CI −2.99 to −0.90, p<0.001). Standardised effect sizes for fatigue impact were MAF 0.59 (95% CI 0.15 to 1.03) and VAS 0.77 (95% CI 0.33 to 1.21), both in favour of CBT. Secondary outcomes of perceived fatigue severity, coping, disability, depression, helplessness, self-effi cacy and sleep were also better in CBT participants. Conclusions Group CBT for fatigue self-management in RA improves fatigue impact, coping and perceived severity, and well-being.

The present study compared the efficacy of a group-based cognitive-behavioural treatment (GCBT) delivered exclusively to parents of young anxious children (between 4 and 8 years of age) with the same intervention delivered to both children and parents, relative to a Wait-list Control condition. Parents of children in the Parent Only condition (N ¼ 25) received 10 weekly sessions of GCBT whereas children and parents in the Parent þ Child condition (N ¼ 24) each received 10 weekly sessions of GCBT. Intent-totreat analyses indicated that both active treatment conditions were superior to the Wait-list condition (N ¼ 11), with 55.3% of children in the Parent Only condition and 54.8% of children in the Parent þ Child condition no longer meeting criteria for their principal diagnosis at post-treatment. These treatment gains were maintained in both treatment conditions at six-month and 12-month follow-up assessments. There were no significant differences between the two active conditions on other outcome measures including parental psychopathology and parenting style. However, an unexpected finding was that parenting satisfaction and to some extent parenting competence reduced significantly from pre-to posttreatment regardless of the active treatment condition. The present results suggest that GCBT delivered exclusively to parents of young anxious children may be a viable treatment alternative for improving accessibility to efficacious treatments for children with anxiety disorders and for reducing costs associated with mental health care delivery.

This study evaluated an inference-based approach (IBA) to the treatment of obsessivecompulsive disorder (OCD) by comparing its efficacy with a treatment based on the cognitive appraisal model (CAM) and exposure and response prevention (ERP). IBA considers initial intrusions in OCD (e.g. ''Maybe the door is open'', ''My hands could be dirty'') as idiosyncratic inferences about possible states of affairs arrived at through inductive reasoning. In IBA such primary inferences represent the starting point of obsessional doubt, and the reasoning maintaining the doubt forms the focus for therapy. This is unlike CAM, which regards appraisals of intrusions as the maintaining factors in OCD. Fifty-four OCD participants, of whom 44 completed, were randomly allocated to CAM, ERP or IBA. After 20 weeks of treatment all groups showed a significant reduction in scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Padua Inventory. Participants with high levels of obsessional conviction showed greater benefit from IBA than CAM. Appraisals of intrusions changed in all treatment conditions. Strength of primary inference was not correlated with symptom measures except in the case of strong obsessional conviction. Strength of primary inference correlated significantly with the Y-BOCS insight item. Treatment matching for high and low conviction levels to IBA and CAM, respectively, may optimize therapy outcome. Key words: obsessive compulsive disorder; cognitive behavior therapy.

The authors provide an overview of the papers in the special issue of Memory on mental imagery and memory in psychopathology. The papers address emotional, intrusive mental imagery across a range of psychological disorders including post-traumatic stress disorder (PTSD), agoraphobia, body dysmorphic disorder, mood disorders, and psychosis. They include work on information processing issues including modelling cravings, conditioning, and aversions, as well as imagery qualities such as vividness and emotionality. The overview aims to place the articles in a broader context and draw out some exciting implications of this novel work. It provides a clinical context to the recent growth in this area from a cognitive behavioural therapy (CBT) perspective. We begin with PTSD, and consider links to imagery in other disorders. The clinical implications stemming from this empirical work and from autobiographical memory theory are discussed. These include consideration of a variety of technique...

A systematic review was conducted of school-based prevention and early intervention programs for anxiety. The aim of the review was to identify and describe the programs available, and to evaluate their effectiveness in reducing symptoms of anxiety. Twenty-seven outcome trials, describing 20 individual programs, were identified through the Cochrane Library, PsycInfo and PubMed databases. Results of the review indicated that most universal, selective and indicated prevention programs are effective in reducing symptoms of anxiety in children and adolescents, with effect sizes ranging from 0.11 to 1.37. Most programs targeted adolescents (59%), were aimed at reducing the symptoms of nonspecific anxiety (67%), and delivered cognitive behavioural therapy (CBT; 78%). Further quality school-based research is required that involves longer-term follow-up, the use of attention control conditions and evaluates teacher delivery.

Although the emotion of anger has, in recent years, been the subject of increasing theoretical analysis, there are relatively few accounts of how interventions designed to reduce problematic anger might be related to cognitively oriented theories of emotion. In this review of the literature we describe how a cognitive-behavioural approach to the treatment of those with anger-related problems might be understood in relation to conceptualizations of anger from a cognitive perspective. Three additional interventions (visual feedback, chair-work, forgiveness therapy) are identified that aim to improve the perspective-taking skills of angry clients. It is concluded that such interventions might be considered for use within the context of cognitive-behavioural treatment.

This article reviews the methods and results of published neuroimaging studies of the effects of structured psychological interventions for mood and anxiety disorders. The results are consistent with neural models of improved affective-and self-regulation, as evidenced by psychotherapeutic modulation of brain metabolic activity within the dorsolateral, ventrolateral, and medial prefrontal cortices, the anterior cingulate, the posterior cingulate/precuneus, and the insular cortices. Specific recommendations for future studies are outlined, and the clinical and theoretical significance of this research is discussed.

Exposure and response prevention (ERP) is a well-established treatment for obsessivecompulsive disorder (OCD). However, it is not completely effective for many patients, and some do not benefit from or tolerate this treatment. Over the past 3 decades there has been growing interest in using cognitive interventions, either as adjuncts or alternatives to exposure-based treatments such as ERP, to address these shortcomings. Cognitive therapy and cognitive behavior therapy for OCD have both demonstrated greater efficacy than no treatment at all, and appear to have a lower incidence of dropout than ERP. Unfortunately, however, for the average OCD patient, cognitive interventions have not improved treatment efficacy; that is, cognitive interventions, either alone or combined with ERP, are no more effective than ERP alone. Reasons for this disappointing result are considered, and indications for the use of cognitive interventions are discussed. Future research directions are suggested in order to evaluate more fully the merits of, and indications for, cognitive methods for treating OCD.

Anorexia Nervosa (AN) is a disorder marked by a persistent disturbance in non-biologically-based, eating-related behaviours, resulting in weight below 85 percent of expected for an individual's height and age (American Psychiatric Association, 2013), driven by fear of gaining weight and disturbed body image. With the highest mortality rate of any of the psychiatric disorders, and with widespread personal, social and economic costs (Surgenor & Maquire, 2013) there is a pressing need to understand and study this disorder. The strong interdependence between AN symptoms makes it vital to determine whether these are cognitive or behavioural in both diagnosis, and deciding how it is best treated. Its onset can be examined through how key similarities and differences in perfectionism, self-esteem, affect and maturity fears are considered contributory in Cognitive Behaviour Theory (CBT) and Family Systems Theory (FST). In treating AN, examining the contributory effects of behavioural and cognitive elements and how CBT techniques work to reduce symptoms, offers insight into the patient’s path to recovery.

This case report of a 31 year old woman who described her main problem as an uncontrollable urge to gamble on electronic gaming machines describes the application of exposure therapy (ET) by videoconferencing and the use of a clinical therapy assistant in the treatment of pathological gambling. The case study is used to demonstrate the effectiveness of this treatment with six sessions of therapy and 4 year follow up. The use of videoconferencing is discussed in relation to treatment effectiveness, ongoing follow up for the client and education and support for a community mental health nurse, therapy assistant, in a rural setting in South Australia. The implications of using this modality for the treatment of rural patients with problem gambling is discussed.

Evidence suggests aerobic exercise has anxiolytic effects; yet, the treatment potential for posttraumatic stress disorder (PTSD) and responsible anxiolytic mechanisms have received little attention. Emerging evidence indicates that attentional focus during exercise may dictate the extent of therapeutic benefit. Whether benefits are a function of attentional focus toward or away from somatic arousal during exercise remains untested. Thirty-three PTSD-affected participants completed two weeks of stationary biking aerobic exercise (six sessions). To assess the effect of attentional focus, participants were randomized into three exercise groups: group 1 (attention to somatic arousal) received prompts directing their attention to the interoceptive effects of exercise, group 2 (distraction from somatic arousal) watched a nature documentary, and group 3 exercised with no distractions or interoceptive prompts. Hierarchal linear modeling showed all groups reported reduced PTSD and anxiety sensitivity (AS; i.e., fear of arousal-related somatic sensations) during treatment. Interaction effects between group and time were found for PTSD hyperarousal and AS physical and social scores, wherein group 1, receiving interoceptive prompts, experienced significantly less symptom reduction than other groups. Most participants (89%) reported clinically significant reductions in PTSD severity after the two-week intervention. Findings suggest, regardless of attentional focus, aerobic exercise reduces PTSD symptoms.

Background: Despite developments in cognitive behavioural therapy for bipolar disorder, little is known about the specific dysfunctional beliefs that may predispose individuals to mania. Therefore a measure was specifically designed for this purpose based on a cognitive approach. The measure is called the Hypomanic Attitudes and Positive Predictions Inventory (HAPPI). Method: Fifty-six individuals with a diagnosis of bipolar disorder and 39 matched healthy controls completed a brief version of the HAPPI (Brief-HAPPI), the Internal State Scale, and the Hypomanic Interpretations Questionnaire (HIQ). Results: The bipolar group scored higher on the overall Brief-HAPPI scale, higher on the forward items of the Brief-HAPPI, lower on the reverse items and no different on the filler items. The group differences in overall score remained when controlling for current self-reported symptoms of mania and depression, and recent history of hypomanic symptoms, yet within the bipolar group, Brief-HAPPI score was positively correlated with the level of symptoms. The Brief-HAPPI showed a sizeable correlation with the HIQ, yet each scale showed a significant and independent association with bipolar disorder. Conclusion: The Brief-HAPPI assesses dysfunctional beliefs that are associated with a diagnosis of bipolar disorder.

s Abstract Helplessness and hopelessness are central aspects of cognitive-behavioural explanations for the development and persistence of depression. In this article a general overview concerning the evolution of those approaches to depression is provided.

This article summarizes the current knowledge and treatment for a specific phobia of vomiting (SPOV). It is relatively uncommon compared to other specific phobias but may have been misdiagnosed in catchment-area surveys. The differential diagnosis of SPOV includes obsessive-compulsive disorder, hypochondriacal disorder and anorexia nervosa. I discuss the following: a model that is linked to past aversive experiences of vomiting; conducting a clinical assessment; making a formulation; psycho-education, engagement and therapy. The strategies employed depend on the formulation but are likely to include: exposure in vivo to cues of vomiting, exposure in imagination and role-plays of vomiting, imagery re-scripting, behavioural experiments; and dropping of safety-seeking behaviours.

Objectives: To review the evidence for the effectiveness of complementary and self-help treatments for anxiety disorders. Data sources: Systematic literature search using PubMed, PsycLit, and the Cochrane Library. Data synthesis: 108 treatments were identified and grouped under the categories of medicines and homoeopathic remedies, physical treatments, lifestyle, and dietary changes. We give a description of the 34 treatments (for which evidence was found in the literature searched), the rationale behind the treatments, a review of studies on effectiveness, and the level of evidence for the effectiveness studies.

Part 1. Piaget's theory makes two important assumptions. First, he assumes that we are born with a species-specific set of biological reflexes that in typical Piagetian fashion, he terms "hereditary organic reactions". These reflexes are biologically programmed behaviors that produce consequences. Second, Piaget assumes that infants are naturally proactive; they spontaneously initiate encounters with the environment. He believed that children "construct" their understanding of the word through their active involvement and interactions. Children learn by doing. He studies his three children to focus not on what they knew but how they knew it. He also, described children's understanding as their "schemas" and how they use: assimilation and accommodation. The internal principles of Piaget's theory areassimilation and accommodation, equilibration, and the functional invariants of organization and adaption. Assimilation is the

We investigated the effectiveness of cognitive behavioural therapy (CBT) and a combined intervention of workplace-and individual-focused techniques among self-employed people on sick leave owing to work-related psychological complaints (such as anxiety, depression, and burnout). Both interventions were based on CBT; however, one was conducted by psychotherapists and involved extensive CBT, while the other was delivered by ''labour experts'' and consisted of a brief CBT-derived intervention combined with both individual-focused and workplace interventions. One hundred and twenty-two self-employed people who had applied for sickness benefit from an insurance company enrolled in a randomized controlled design. These individuals were assessed before the intervention and then at 4 months and 10 months after the onset of the intervention. The outcome was assessed based on duration of sick leave until partial and full return to work and on psychological complaints. Significant effects on partial and full return were found in favour of the combined intervention: partial return occurred 17 and 30 days earlier in this group than in the CBT group and the control group, respectively. For full return to work, the difference was approximately 200 days. A decrease in psychological complaints was present in each condition but we found no significant interaction effects. The results suggest that work resumption should be addressed earlier in individuals receiving CBT. This insight is of value for the (scarce) literature concerning interventions for individuals who are on sick leave owing to work-related psychological complaints.

Background: Attention deficit hyperactivity disorder (ADHD) in adulthood is not fully treated by psychopharmacological treatment alone. The main aim of the current study was to evaluate a newly developed cognitive behaviour therapy (CBT) based group programme, the Reasoning and Rehabilitation for ADHD Youths and Adults (R&R2ADHD), using a randomized controlled trial. Methods: 54 adults with ADHD already receiving psychopharmacological treatment were randomly allocated to an experimental (CBT/MED) treatment condition (n = 27) and a 'treatment as usual' (TAU/MED) control condition (n = 27) that did not receive the CBT intervention. The outcome measures were obtained before treatment (baseline), after treatment and at three month follow-up and included ADHD symptoms and impairments rated by independent assessors, self-reported current ADHD symptoms, and comorbid problems.

This paper reviews the recent literature on psychological treatments for childhood post-traumatic stress disorder and evaluates them in light of the level of evidence supporting their effectiveness. The authors examine an array of Cognitive-Behavioural treatments, including Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT), eye movement desensitization and reprocessing (EMDR) and Group-Delivered Cognitive-Behavioural Therapies (GD-CBT), and also a number of other approaches. The paper concludes that the strongest evidence supports the use of TF-CBT for a wide range of ages and traumas. EMDR is also well supported. Group CBT therapies also have some support especially in response to community-wide traumatic events. A number of other approaches, including some emerging therapies, are identified as meriting further research, whereas others are seen to have little evidence supporting their effectiveness. It identifies that one common approach, critical incident stress debriefing, has little support and may have some negative effects. The review identifies a number of challenges for clinical psychologists, including the dissemination of recent evidence to decision-makers.

Personalized cognitive-behavioural therapy for obesity (CBT-OB) is a new treatment that combines the traditional procedures of standard behavioural therapy for obesity (i.e., self-monitoring, goal setting, stimulus control, contingency management, behavioural substitution, skills for increasing social support, problem solving and relapse prevention) with a battery of specific cognitive strategies and procedures. These enable the treatment to be individualized, and to help patients to address the cognitive processes that previous research has found to be associated with treatment discontinuation, the amount of weight lost and long-term weight-loss maintenance. The treatment programme can be delivered at three levels of care, outpatient, day hospital and residential, and includes six modules, which are introduced according to the individual patient's needs as part of a flexible, personalized approach. The primary goals of CBT-OB are to help patients to (i) achieve, accept and maintain healthy weight loss; (ii) adopt a lifestyle conducive to weight control; and (iii) develop a stable "weight-control mindset". A randomized controlled trial has found that 88 patients suffering from morbid obesity treated with CBT-OB followed a period of residential treatment achieved a mean weight loss of 15% after 12 months, with no tendency to regain weight between 6 and 12 months. The treatment efficacy is also supported by data from a study assessing the effects of group CBT-OB delivered in a real-world clinical setting. In that study, 77 patients with morbid obesity who completed the treatment achieved 9.9% weight loss after 18 months. These promising results, if confirmed by future clinical studies, suggest that CBT-OB has the potential to be more effective than traditional weight-loss lifestyle-modification programmes.