The high prevalence of post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) comorbidity is well established, with comorbidity rates often between 30 and 50%. However, despite the high prevalence of this comorbidity, very few researchers have explored specific treatments for individuals who present with comorbid PTSD and MDD. Further, there has not been explicit examination of the mechanisms through which MDD influences trauma-focused therapy. As individuals with comorbid PTSD and MDD often present with a more chronic course of impairment and in some instances, a more delayed response to treatment, the need for such research is imperative. It will be proposed that there is merit in targeting depression within the treatment of comorbid PTSD and MDD. Accordingly, in this article we review explanations for the high PTSD and MDD comorbid relationship and highlight variables likely to explain such comorbidity. Theoretical accounts for how depression impedes optimal recovery from PTSD and the associated empirical findings are illustrated. We consequently argue that there is a need to develop and test treatments that target both PTSD and MDD symptoms. Directions for future research are highlighted.

Background and objectives: Pretreatment attention bias towards threat stimuli has been shown to predict treatment outcomes following exposure-based treatments. The extent of emotional variability experienced during exposure therapy has also been found to predict better treatment outcomes in anxious adults. The present study examined whether pretreatment attention bias towards threat stimuli and greater emotional variability during exposure activities were associated with stronger treatment outcomes in anxious children receiving group-based cognitive-behavioural therapy (CBT). Methods: Twenty-six anxious children completed a visual probe task with emotional faces, followed by a 10-week CBT program in a group format. Children completed weekly within-session exposure activities during the last 5 weeks of group CBT. Results: Pretreatment attention bias towards threat stimuli, greater emotional variability and within-session habituation during exposure activities were significantly associated with reductions in clinician- and/or parent-rated anxiety symptoms after the 10-week CBT program. Treatment responders had significantly higher peak emotional distress ratings during exposure activities. However, threat attention bias and within-session exposure measures were not significantly related. Conclusions: Pre-existing individual differences in attention bias to threat cues and the degree of emotional reactivity experienced during exposure activities are both important independent predictors of treatment outcomes for anxious children receiving group-based CBT.

Trichotillomania (TTM) is characterised by the removal of one's hair, causing hair loss. Phenomenological research on TTM has investigated its associated behavioural and affective factors. Few studies have investigated the possible role of cognitions and beliefs, despite emerging support for cognitive therapies in treating this disorder. This study aimed to explore and describe the cognitions and beliefs that contribute to the onset and maintenance of hairpulling in TTM. Eight women with TTM participated in semi-structured, in-depth interviews to explore their experience of cognitions and beliefs before, during and after typical hairpulling episodes. Interviews were analysed using the qualitative method of Interpretative Phenomenological Analysis. Six superordinate themes of beliefs were identified as important: negative self-beliefs, control beliefs, beliefs about coping, beliefs about negative emotions, permission-giving beliefs, and perfectionism. These preliminary findings suggest that cognitions may play an important role in TTM phenomenology. Future quantitative research on the role of cognitions and beliefs in TTM in larger samples has the potential to advance cognitive-behavioural models and treatments of this poorly understood disorder.

Explanations implicating memory in the causes and severity of checking symptoms have focused primarily on retrospective memory, and relatively little attention has been paid to prospective memory. Limited research has examined the relationship between prospective memory and executive functions. We assessed whether impairments in prospective memory and executive function predict checking symptoms in a sample of 106 adults. Checking symptoms were assessed using the Padua Inventory Washington State University Revision (PI-WSUR). All participants completed the prospective memory questionnaire (PMQ) and four computerised executive function tasks from the CANTAB, measuring inhibition, planning, attention set-shifting and working memory. Prospective memory and inhibition predicted checking symptom severity. Importantly, there were no correlations between internally cued prospective memory and inhibition or between prospective memory aiding strategies and inhibition. These variables appear to have an independent role in checking. The current findings highlight prospective memory and inhibition as key contributors to the checking symptom profile and provide the first evidence that these cognitive processes may independently contribute to checking symptoms. These findings have implications for a model in which memory performance is thought to be secondary to impairments in executive functions.

Background: Preschool-aged children exhibit a relatively high prevalence rate of anxiety disorders, and the course of these disorders is often chronic. However, surprisingly few studies have focused on the treatment of anxiety in this age group. In response to this limitation, the purpose of the current study was to examine the effectiveness of an open trial of the Fun FRIENDS (FF) program, a downward extension of the FRIENDS programs for preschool-aged children (5–7 years), in a community clinic setting. Method: The sample included 31 children diagnosed with an anxiety disorder. Treatment consisted of 10 weekly sessions administered in a group format. Parents also received two information sessions. Child anxiety, behavioural inhibition, and resiliency were assessed at preintervention, immediate postintervention, and at 12-month follow-up. Results: Significant decreases in child anxiety and shyness and improvements on measures of resiliency were observed following the completion of treatment. Conclusions: The results of this study provide support for the effectiveness of the Fun FRIENDS program as a treatment for anxiety in young children. Further, this study adds to the relatively small body of research focused on the use of CBT to treat anxiety disorders in this population.

High-functioning children with autism spectrum disorders display social skill deficits that can have a debilitating impact on their daily lives. The Secret Agent Society (SAS) program has been shown to be effective in improving the social skills of these children when delivered in a group setting. This pilot study evaluated whether individually delivered SAS would yield similar outcomes. Three participants were recruited for the 9-week intervention. Measures of social competence were administered at four points: pretest 1, pretest 2, post-intervention, and 6-week follow-up. Participants showed significant improvement in half of the measures assessing social competence. On a third of these measures, two participants demonstrated improvements to within the range of their typically developing peers. Follow-up results suggested that improvements were maintained at 6 weeks’ post-intervention. Limitations of this study and directions for future research are discussed.

One means by which Intolerance of Uncertainty (IU) purports to contribute to anxiety is by increasing Threat Perception (TP). This process was examined by comparing two different definitions of uncertainty: ambiguity versus unpredictability. N = 104 participants were measured for IU and then made worry and TP estimates for four different scenario types: Ambiguous Scenarios (where an outcome could be interpreted as threatening), Unpredictable Positive Scenarios (where a surprising and positive outcome was anticipated), as well as Positive and Negative Scenarios (with certain outcome). Both Ambiguous and Unpredictable Positive Scenarios more strongly predicted the relationship between IU and worry scores than (certain) Positive or Negative Scenarios. The relationship between IU and ‘ambiguous worry’ was largely explained by TP estimates, whereas the relationship between IU and ‘Unpredictable Positive Worry’ was largely independent of TP. Results suggest ambiguity and unpredictability are differentially explained by TP such that they produce different types of response. The authors argue ambiguity and unpredictability are explanatory components within IU.

Impaired action processing may be a key feature of the obsessive-compulsive checking phenomenon, although the mechanism underlying the impairment remains to be explored. We examined the ability to parse a continuous flow of movements and perceptual changes into meaningful segments of action — a key component of action processing — in checking proneness. Participants (N = 65) completed a measure of obsessive-compulsive symptoms and, while viewing four videotaped movies, were requested to detect the transitions between significant action steps. The main result indicated that Checking — but not the other obsessive-compulsive dimensions — was negatively related, with the size of meaningful units identified. These findings suggest that checking proneness may be specifically connected with difficulties in processing actions on the basis of abstract features such as goal-related information. This could explain why people with checking symptoms find it more difficult to determine whether an intended goal has actually been achieved.

Perfectionism has been argued to have both positive and negative aspects. Negative perfectionism has a robust positive correlation with psychopathology. This study explored the personality pattern of a group of clinical participants and a group of athletes in relation to positive and negative perfectionism. The results indicated negative perfectionism is related to neuroticism and agreeableness in both clinical and non-clinical groups. Negative perfectionism was most strongly associated with low agreeableness but had no significant relationship with conscientiousness or extraversion in the clinical sample. In the athlete sample, higher negative perfectionism was most strongly related to higher neuroticism but was also associated with lower extraversion and conscientiousness. In order to more fully understand these relationships and their clinical implications, more studies using validated measures of positive and negative perfectionism with larger samples are required. It would be useful to determine if personality factors of agreeableness and competence could be increased in order to ameliorate the distress associated with negative perfectionism.

This study explored the relationship between self-reported and observed mealtime behaviour and examined concurrent predictors of observed child and parent mealtime behaviour. The sample consisted of 67 parents of 1.5- to 6-year-old children experiencing difficulties with their child's mealtime, and 33 parents who were not concerned with their child's mealtime behaviour. Parent-reported and observed mealtime data, and parent-reported mealtime cognitions were collected. Regression analyses indicated that consistent with hypotheses, observed and parent-reported mealtime behaviour were related. Observed child behaviour was predicted by self-reported parenting behaviour and observed positive parent behaviour, as well as parental cognitions. Observed parent behaviour was predicted only by self-reported parenting mealtime behaviour.

Objective: The aim of the current study was to compare the effects of instructed cognitive reappraisal, acceptance and emotional suppression on state anger after provocation among individuals with high trait anger. The moderating effects of trait emotion regulation (ER) styles were also examined. Method: Adults (N = 102) with elevated levels of trait anger were randomised to one of three ER conditions. Participants in both the reappraisal and emotional suppression conditions reported a decline in state anger and systolic blood pressure (SBP) post-anger provocation, whereas participants in the acceptance group did not experience a substantial decline in state anger or SBP post-anger provocation. Trait suppression was further found to enhance the effects of instructed suppression, while trait tolerance augmented the effects of instructed reappraisal. Conclusions: Support was found for the use of reappraisal and emotional suppression as adaptive strategies to cope with anger arousal in the short term after provocation.

There is evidence that the school-based program FRIENDS for Life is effective in preventing childhood anxiety and depression. Effectiveness is, however, not the only prerequisite for successful implementation. Participants’ evaluation of a prevention program may provide suggestions about how to fine-tune it to fit the needs of the target population. This study investigated children's and parents’ evaluations of the Dutch version of FRIENDS for Life. Forty-four participants of FRIENDS for Life (9–13 years) participated in online focus groups and 38 parents were interviewed in 2011–2012. Questions concerned the general opinion about the program, its perceived effectiveness and group atmosphere, and suggestions for program improvement. Most children (95.5%) and parents (65.8%) evaluated the program positively, and the majority (61.4% and 76.3%) thought that it had been useful in changing the child's behaviour. Children and parents expressed complementary views about the behaviours the child had learned. Some children (38.6%) expressed negative opinions about the program. Parents’ attendance at parent meetings was low (31.6–36.8%). Considered together with the growing evidence of the effectiveness of FRIENDS for Life, we concluded that it can be successfully implemented as an indicated prevention program in primary schools for children who show symptoms of anxiety or depression. Efforts could be made to increase parents’ involvement in the program.

Being able to read at a fluent rate confers many advantages on an individual in both educational and wider social contexts throughout life. To be a fluent reader means that the individual can sustain high accuracy while reading at a rate appropriate to the material and the setting, and implies the development of automaticity in the cognitive processes involved in reading. Fluency has not, however, been the focus of much research. In this study, an observational learning technique — feedforward video self-modelling (FFVSM) — was used to improve children's reading fluency. Eleven primary (elementary) school children aged between 72 and 108 months, four girls and seven boys, viewed edited video footage of themselves seemingly reading a difficult text at a fluent rate six times over a 2-week period. Reading performance (accuracy, comprehension and rate) was measured at pre- and post-test using the Neale Analysis of Reading Ability, and fluency and comprehension scores were measured across the intervention period using the Science Research Associates Reading Laboratory (SRA) graded reading texts. The results showed that the majority of the children improved their reading fluency, comprehension and accuracy as well as reader self-perception (a proxy measure of self-efficacy). These positive results suggest that FFVSM could be a rapid, cost-effective intervention to be used within educational settings to promote fluent reading.

Introduction: Eating disorder symptoms already occur in childhood and adolescence and are predictive of full-blown eating disorders and obesity later in life. To enhance the quality of assessment in youngsters, this study examined the convergence between the clinical interview, the Child Eating Disorder Examination (ChEDE), and the self-report questionnaire, the Child Eating Disorder Examination-Questionnaire (ChEDE-Q). Method: Both instruments were administered in 12- to 16-year-old boys and girls retrieved from the general population (N = 57, Mage = 13.4). Results: The results showed that there was a strong correlation between the interview and the questionnaire and that the subscale scores of the two research instruments did not significantly differ. Discussion: The present study is among the first to confirm the utility of the ChEDE-Q to screen for eating disorder symptoms in adolescents from the general population. Large-scale studies should further determine whether these preliminary findings can be generalised.

Anticipatory processing (AP) is a repetitive thinking style associated with social anxiety that has been understudied relative to other similar constructs (e.g., rumination, worry). The primary goal of this study was the development and evaluation of the Positive Beliefs about Anticipatory Processing Questionnaire (PB-APQ) with a sample of 301 undergraduate students. Further, it was predicted that anticipatory processing would mediate the relationship between positive beliefs about anticipatory processing and social interaction anxiety. The findings from this study suggest that PB-APQ is a valid and reliable construct. Anticipatory processing was shown to partially mediate the relationship between positive beliefs about anticipatory processing and social interaction anxiety. The results provide initial evidence for the suggestion that individuals who tend to hold positive beliefs about anticipatory processing tend to engage in anticipatory processing, which may increase social interaction anxiety.

This article appraises the ability of several measures, assessing symptomatology theoretically relevant to generalised anxiety disorder (GAD), to accomplish successful classification of individuals with DSM-IV GAD and individuals with mood or other anxiety disorders. Participants were 197 individuals (average age = 36.43; 67.5% female) receiving treatment at a clinic, who completed pretreatment self-report measures. Receiver operator characteristic analyses and logistic regression analyses were employed to determine the classificatory abilities, including sensitivity and specificity, of several GAD relevant measures. The Penn State Worry Questionnaire (PSWQ) accomplished significant classification in both comparison group dyads: GAD-Anxiety and GAD-Mood. Whereas the general distress of depression subscale of the Mood and Anxiety Symptoms Questionnaire (MASQ) accomplished significant classification in the GAD-Anxiety group dyad, both the general distress of anxiety and anxious arousal subscales of the MASQ did so in the GAD-Mood group dyad. Only the PSWQ significantly predicted the presence of GAD, while controlling for other symptom variables. Though evidence supports the uniqueness of some symptoms of GAD, including worry, often considered pathognomonic to GAD, the modest areas under the curve, sensitivity, and specificity of the measures afford tenuous support for the utility of these measures. The lack of highly sensitive and specific symptomatology comport with critiques of GAD as a diagnostically delimited category.

This prospective experimental study sought to examine the unique effects of emotion dysregulation and impulsivity on risky behaviours over time. To this end, 20 African American women enrolled in a historically Black university in the southern United States were randomly assigned to receive one of two brief empirically supported skills training modules (i.e., emotion modulation [EM] or impulsivity reduction [IR]). Participants completed measures of emotion dysregulation, impulsivity, and past-week risky behaviours before (pre-) and one week after (post-) the experimental manipulation. Participants assigned to the EM condition reported significant improvements from pre- to post-manipulation in overall emotion dysregulation (as well as all specific dimensions of emotion dysregulation other than lack of emotional awareness), as well as two dimensions of impulsivity: negative and positive urgency. Participants assigned to the IR condition reported a significant decrease in one dimension of impulsivity (lack of premeditation) from pre- to post-manipulation. Findings also revealed a significant effect of time on risky behaviours, with participants reporting significantly fewer past-week risky behaviours at the post- (vs. pre-) manipulation assessment. Finally, changes in emotion dysregulation from pre- to post-manipulation accounted for the observed reduction in risky behaviours over time (above and beyond changes in impulsivity dimensions). Results highlight the relevance of emotion dysregulation to risky behaviours and suggest that treatments targeting emotion dysregulation may be useful in reducing risky behaviours.

Self-help cognitive behaviour therapy has been found helpful in treating anxiety and depression. Recent evidence suggests that self-help schema therapy may represent another treatment alternative. The present study aimed to provide a preliminary assessment of the efficacy of self-help schema therapy on psychological distress and early maladaptive schemas (EMSs) using a 6-week treatment protocol with minimal email contact. Method: Participants were recruited from the general population and randomly assigned to self-help schema therapy (n = 32) or a waitlist (n = 32). Intent-to-treat analyses and study completer analyses were conducted using repeated-measures analyses of variance (time × group). Results: Intent-to-treat analyses revealed that treatment produced a marginal improvement in distress, but no change in EMSs. Among study completers (n = 34), self-help schema therapy yielded large reductions in distress scores on the Outcome Questionnaire-45.2 (partial eta squared = .16). Compared to the waitlist, self-help schema therapy also produced a moderate decrease in EMSs (partial eta squared = .10). The majority of study completers showed reliable clinical change in distress and reported high levels of satisfaction with the intervention. Conclusion: Self-help schema therapy may be an effective treatment for those individuals who persist in treatment. Self-help schema therapy has the potential to help a large number of individuals who may not otherwise have access to services. More research is needed to determine variables associated with treatment adherence and successful outcome.

The aim of this study was to assess the effects of a partially parent-implemented self-management intervention incorporating video-modelling for discrimination training on improving social skills in a child with autism spectrum disorder (ASD). The participant was a 9-year-old girl with ASD. A multiple baseline across behaviour design (no interruption, asking for opinions, and appropriately greeting unfamiliar adults) was used to assess the effects of the intervention. Results showed: (a) the intervention was associated with improvements in all target behaviours in the training setting with a strong overall treatment effect; (b) the behavioural gains were generalised to non-training settings and maintained in both fading and follow-up phases; and (c) social validity measured by the Behavior Intervention Rating Scale — Adapted version (pre- and postintervention) was high. The intervention was effective in improving social skills with this participant, with good generalisation and maintenance effects and high social validity.

The traditional approach to headache trigger management is to advise avoidance of all triggers, but we have advocated an alternative approach called ‘Learning to Cope with Triggers’ (LCT), in which the objective is to desensitise headache sufferers to some triggers or to build up tolerance for the triggers, using exposure techniques. A recent publication established the efficacy of this approach to trigger management. Reported here are three cases to illustrate how LCT is used in practice. Two cases were male and one was female, with ages ranging from 32 to 67 years. The headache diagnoses were frequent episodic tension-type headache, migraine without aura, and chronic tension-type headache; all had had headaches since childhood/adolescence. The headache triggers that were the focus of the intervention were heat, tiredness, and stress/anger. Post-treatment, changes in the capacity of the triggers to elicit headaches were reported in all three cases. Reductions in headaches from pre- to post-treatment, and from pre- to 4-month follow-up, were: case 1, 69% and 60% respectively; case 2, 76% and 80% respectively; and case 3, 73% and 61% respectively. Decreases in medication consumption, and enhanced self-efficacy were also recorded.