Background: Computer-guided CBT has been shown to be a potentially useful way of closing the gap between the demand and supply for CBT. Moreover, this approach has additional benefits in terms of less travel times for treatment, accessibility in remote and unusual locations, increased confidentiality, easier disclosure of sensitive information, and more egalitarian therapist-client interactions. Research on computerized CBT has concentrated on clinical outcomes, but the views of clients on this treatment approach have been relatively neglected. Aims: The aims were to assess client satisfaction, professionals' views, and ease of programme use after completion of treatment via an internet-based CBT programme for panic and phobic anxiety (FearFighter). Method: A feasibility and effectiveness study of FearFighter was conducted in remote and rural areas of Scotland. Treatment data are available for 35 clients at post-treatment, of whom 29 completed an 18-item set of rating scales designed to assess satisfaction, including ease of use, accessibility, how far needs were met, whether changes to the programme were required, the benefits and drawbacks of not having a therapist, and quality of support. Open-ended questions were included. Referring agencies were also asked to rate their views on FearFighter. Results: Clients reported moderate to high levels of improvement and of overall satisfaction; very few difficulties in logging on to and using the programme were encountered. Similar levels of satisfaction with the programme were reported by referrers. Conclusions: It is concluded that computer-guided CBT is acceptable to clients and to professionals, and that it could play a valuable part in a “stepped care” system of delivering CBT.

Background: A key component of cognitive therapy for psychosis is the development of a meaningful and shared formulation of the onset of the psychosis. Therapists bring an understanding of the development of psychotic symptoms based on theoretical models and try to marry these with the person's own experience and explanations. However, an important question is whether this understanding is compatible with the explanations held by the client. Aims: This study investigated what factors people believed led to the onset of their psychosis. Method: A Q set of potential causes for psychosis was identified from a literature search and interviews with people with differing experiences of psychosis. From this, 58 potential causes of psychosis were identified. Twenty-one people who had experienced a psychotic breakdown then ranked these explanations as possible causes. Results: Using Principle Components Analysis four main factors were identified as perceived causal factors for the onset of psychosis. These factors were described as: a) drug usage; b) traumatic experiences in adulthood; c) personal sensitivity; and d) developmental vulnerabilities. Conclusions: This study revealed that people with psychosis have different explanatory frameworks for the onset of their difficulties. This work is helpful as this effort to understand the person's own understanding of their problems is a first stepping stone towards a collaboratively generated formulation that may be helpful in building a therapeutic alliance, engagement in treatment, and ultimately in improved outcome. It is likely that these different explanatory frameworks could lend themselves to different treatment approaches.

Background: Recent work in the area of cognition and emotion has focused on the process as well as the content of thought. Metacognitive approaches have included studies of people's relationship with internal experience (cf. Teasdale and Barnard, 1993), and the overarching beliefs that guide allocation of internal resources to manage distress (cf. Wells, 2000). At the same time, cognitive models of psychosis have emphasized the clinical value of a multidimensional understanding of paranoia (Chadwick, 2006; Freeman and Garety, 2004b). Method: This study examined paranoia in a non-clinical group, specifically (i) the relationship between a single measure of trait paranoia and dimensions of paranoid thought frequency, belief conviction and distress, and (ii) the metacognitive strategies that people use. It was predicted that trait paranoia would be associated with (i) dimensions of thought frequency, belief conviction and distress, and (ii) the internal strategies of “punishment” and “worry.” Results: Regression analyses showed that trait paranoia uniquely predicted frequency, conviction and distress associated with paranoid thoughts. Trait paranoia accounted for the use of “reappraisal”, whereas “punishment” and “worry” were accounted for by anxiety. Conclusions: The implications for clinical work and further research are discussed.

Background: Psychiatric staff play a key role in the lives of people with psychosis and the quality of staff and service user relationships is associated with relapse and recovery. One factor that might determine the capacity of staff to form positive therapeutic relationships is their appraisals of service users' mental health problems. Method: A pilot intervention was implemented with psychiatric staff that involved helping them develop psychological formulations for individual service users. Staff perceptions of service users' mental health problems were measured before and after the intervention using Likert scales. Data at the two time points were collated for 30 staff. Results: There was a significant increase in staff perceptions of the degree of control service users and themselves had over problems, an increase in the degree of effort they felt service users were making in coping, reductions in blame, and more optimism about treatment. Staff also reported an increase in understanding of service users' problems, more positive feelings towards service users, and an increase in confidence in their work. Conclusions: Results from this pilot are promising, but findings warrant replication in controlled studies. It is also important to establish whether changes in staff perceptions influence the actual nature of staff-service user relationships.

Background: The development and maintenance of gambling and problem gambling with its corresponding irrational beliefs may be fundamentally linked to patterns of wins and losses during electronic gaming machine (EGM) play. Method: The current study investigated the extent to which irrational thoughts and erroneous perceptions of chance differed based on individual wins or losses. Undergraduate students (n = 45) completed questionnaires assessing irrational beliefs and perceptions of chance prior to and following EGM play with credits rather than money. Results: It was found that players who lost reported a significantly greater decrease in irrational thoughts and erroneous perceptions of chance and significantly fewer superstitious beliefs than winning players following play. Conclusions: Future studies are needed to further investigate the relationship of winning to cognitive distortions to guide education and interventions.

Background: Cognitive Behaviour Therapy self-help has been recommended in the NICE guidelines for the treatment of anxiety and depression. However, little is known about who benefits from self-help and the potential drawbacks and problems of using this approach. Aims: To address the current gap in knowledge, we contacted accredited BABCP practitioners to examine practitioner use and attitudes to self-help, current trends of use, and to identify possible problems with this therapy. Method: A 50% random sample of all accredited BABCP practitioners was approached, and the overall response rate for the survey was 57.6%. Results: Self-help materials were seen positively by therapists and were used by 99.6%, mainly as an adjunct to individual therapy. Only 38.2% had been trained in the use of self-help, with those trained being more likely to recommend self-help. Higher levels of patient motivation, credibility, likely adherence, self-efficacy and a lower degree of hopelessness were the five factors identified by more than 70% of respondents as predicting successful patient outcome with self-help. Non-compliance and a lack of detection of a worsening of the patient's clinical state due to reduced therapist contact were viewed as being the most important problems with self-help by more than 70% of respondents. Conclusions: Preferable patient characteristics for self-help have been identified, as have potential problems and adverse consequences.

Background: The likelihood of developing depression increases throughout adolescence. Aims: Understanding the relative contribution of psychosocial and cognitive variables to depressive symptoms during the transitional stage of late adolescence should increase the scope for effective prevention and intervention. Method: The Inventory of Parent and Peer Attachment (IPPA), Adolescents' Cognitive Style (ACSQ), Relationship Rating Scales (RRS), The Life Events Checklist, and the Children's Depression Inventory (CDI) were completed by 140 adolescents aged 16–18 years. Results: Alienation from parents and peers, helpless attributional style, gender, and perceived criticism from teachers contributed significantly to variance in scores for depressive symptoms. Negative self-inference and helpless attributions moderated the relationship between perceived criticism and depression in male participants. Conclusions: Different approaches to intervention may be more successful for males and females.

Background: The present paper describes the cognitive-behavioural approach evolved and adapted to treat survivors of the London bombings experiencing fear and avoidance of public transport (travel phobia). Method: Treatment outcomes for a consecutive case series (N = 11) are reported. Results: All individuals who completed treatment (N = 10) had returned to their pre-bombing use of transport and reported minimal symptoms. Conclusions: The need for appropriately tailored treatment based on differential diagnosis and formulation and the importance of incorporating skills for treatment of posttraumatic stress disorder are discussed.

Background: Recent research into positive experiences in caregivers has begun to redress the traditional focus on negative aspects of caregiving experiences. Method: This exploratory study used a cognitive-behavioural approach – namely, the transactional stress model (Lazarus and Folkman, 1984) – to investigate associations between appraisals, coping, and gains over a 6-week period in a small sample (N = 4; case series) design involving stroke caregivers. Analysis involved visual inspection of graphs, supported by descriptive statistics, and co-variation analysis. Results: Participants reported high levels of positive experiences, and these increased over the study period, a previously unreported trend. The study also found individual differences in the interactions between appraisal, coping, and caregiving gain variables, findings explained by the transactional stress model. Conclusions: Implications for clinical practice and future research are addressed.

Hairpulling (trichotillomania) is often linked to stressful circumstances and may produce feelings of guilt, shame and humiliation. In a behavioural model, affective experience was identified as an important maintaining factor, as both a cue and reinforcer. Habit Reversal is one of the more successful behavioural treatment options. The present study evaluated the role of emotional arousal in the intensity of urges to pull hair in a teenaged patient with trichotillomania. Using an experimental ABCD/DCBA reversal design, the patient used imagery to increase her emotional arousal through the presentation of a manipulation script based on her own experience, after baseline and during a rumination, cognitive and a behavioural distraction phase. Subjective measures of urge intensity were collected at five time points during completion of a task, and a tally was made of an overt hair touching behaviour operationalized as a hairpulling substitute behaviour. The patient experienced more intense urges to pull whilst ruminating on the arousal script compared to either of the distraction phases. The findings support the view that the experience of negative emotional arousal can exacerbate and intensify the experience of urges to pull hair in patients with trichotillomania, and that both cognitive and behavioural distraction techniques have some effect in controlling them. Demonstrating this to the patient aided engagement in treatment.

Behavioural and Cognitive Psychotherapy is an international multidisciplinary journal for the publication of original research, of an experimental or clinical nature, that contributes to the theory, practice and evaluation of behaviour therapy. As such, the scope of the journal is very broad and articles relevant to most areas of human behaviour and human experience, which would be of interest to members of the helping and teaching professions, will be considered for publication.