Clinical Psychology and Psychotherapy (An International Journal of Theory & Practice)

Sharp, D. M.; Power, K. G.; Swanson, V.

doi: 10.1002/cpp.393pmid: N/A

Panic disorder and agoraphobia is a prevalent clinical condition which places heavy demands on treatment resources in primary care. The efficient delivery of evidence‐based psychological treatment for this disorder is therefore important. Previous research has investigated both individual and group treatment formats for cognitive behaviour therapy (CBT) for panic disorder and agoraphobia. These two modalities of treatment delivery are, however, rarely compared within the same study format. Also little is known of patients' preferences regarding treatment delivery formats. The present study investigated the relative efficacy of a group treatment CBT and an individual treatment CBT in comparison with a waiting list control group in the treatment of panic disorder with or without agoraphobia in primary care. Ninety‐seven patients suffering from DSM‐IV panic disorder with or without agoraphobia were randomly allocated to receive either group CBT, individual CBT, or waiting list control. All patients were seen by the same therapist and all received an identical treatment manual. Treatment response was measured by blind assessor, therapist and patient‐rated measures of anxiety, depression, and agoraphobic avoidance, and was analysed in terms of both traditional statistical significance and clinical significance of outcome. At treatment end‐point, in terms of traditional statistical significance, both the group and individual CBT were significantly superior to waiting list control but did not differ significantly from each other. When clinical significance of outcome at treatment end‐point was considered, individual CBT showed a significant advantage over both group CBT and waiting list control. At 3‐month follow‐up, however, the individual CBT treatment group showed significant superiority to the group CBT treatment on clinical significance of outcome on one outcome measure only. This was principally due to a reduction in the proportion of patients achieving criteria of clinically significant change in the individual CBT treatment group over the 3‐month follow‐up period. When given a free choice of group or individual CBT at the end of the waiting list period, the overwhelming majority (95%) of the waiting list patients chose individual CBT. The implications of these findings for future research and for wider clinical practice are discussed. Copyright © 2004 John Wiley & Sons, Ltd.

Wheatley, Malcolm; Waine, Jo; Spence, Kiran; Hollin, Clive R.

doi: 10.1002/cpp.398pmid: N/A

Despite the recognition of the need for secure adolescent mental health provision, the extent and precise nature of the services required in the United Kingdom remains unquantified. The present study describes some of the key characteristics of 80 young people referred from around the United Kingdom for medium secure health care. The pattern of referrals indicates a substantial need for secure health care in the 14‐ to 18‐year‐old age range. Young people requiring such care present most commonly with psychotic, personality or post traumatic stress disorder. Nearly half of the young people (45%) were requiring constant observation. Over 90% of those assessed presented a risk of aggression and over 60% presented a suicide risk. Over half (53%) had been charged with one or more offence and 29% had at least one conviction. The need for the further development of an adolescent forensic specialism is supported by these data. Copyright © 2004 John Wiley & Sons, Ltd.

Vincent, Paula J.; Boddana, Pradeep; MacLeod, Andrew K.

doi: 10.1002/cpp.394pmid: N/A

Parasuicidal individuals lack positive expectations about the future. This study set out to examine two aspects of positive future thinking—the ability to think of goals and the presence of cognitions related to achieving those goals, including plans, perceived control and perceived likelihood. Individuals who had recently engaged in an episode of parasuicide (N = 24) were compared with matched, hospital controls (N = 24) on a range of measures to assess number and type of goals, ability to think of plans to achieve goals, sense of control over goal outcomes, and perceived likelihood of achieving goals, as well as self‐report measures of hope, hopelessness, depression and anxiety. The two groups did not differ in the number of goals they could identify, especially after controlling for unemployment. The groups did differ in the quality of goals with the parasuicide patients' goals being less specific and more self‐focused in important goals, though these effects were confounded by group differences in employment status. Compared to controls, and after controlling for employment, parasuicide patients gave less specific plans, could think of more obstacles to achieving their goals and gave lower ratings of control and likelihood of achieving their goals. Parasuicide patients appear able to think of positive life goals but have clear problems in being able to think of how to achieve those goals. Copyright © 2004 John Wiley & Sons, Ltd.

Belloch, Amparo; Morillo, Carmen; Lucero, Mariela; Cabedo, Elena; Carrió, Carmen

doi: 10.1002/cpp.397pmid: N/A

This study explores the frequency of the appearance of intrusive thoughts in normal people, as well their association with cognitive appraisals and control strategies. A total of 336 subjects completed the Spanish adaptation of the Obsessional Intrusions Inventory‐Revised (ROII), designed by Purdon and Clark (1993, 1994a, 1994b). Most of the subjects (99.4%) reported experiencing intrusive thoughts occasionally, but only 13% reported having them with some frequency. The intrusions were included in two factors: aggression, sexually and socially inappropriate behaviours, and doubts, checking, and cleanliness. The frequency of appearance of the most upsetting intrusive thought was associated with: the likelihood/probability bias, the need to control the thoughts, and neutralizing strategies. Nevertheless, the unpleasantness was associated with the morality bias and a broad range of control strategies. These results are discussed in relation to the different roles that the appraisal and the thought control responses play, both regarding the persistence as well as the unpleasantness associated with the most upsetting intrusions. Copyright © 2004 John Wiley & Sons, Ltd.

Phillips, Anna; Hatton, Chris; Gray, Ian

doi: 10.1002/cpp.399pmid: N/A

Concerns have frequently been raised about equal opportunities in the short‐listing and selection procedures used by clinical psychology training courses, although little evidence exists. The aim of the study is to identify factors predicting short‐listing and selection to clinical psychology training courses. A prospective study of one national cohort of applicants to UK clinical psychology training (the 2000 entry cohort of 1538 applicants) was carried out. Application forms (n = 1538), references (n = 1538) and postal questionnaires (n = 396) were used to collect demographic, biographical, academic and work experience information. Relationships between these variables and short‐listing or selection to training were examined using univariate odds ratios and effect sizes, and multivariate logistic regressions. Factors most strongly predictive of short‐listing and selection were proxies for academic ability (post‐16 education at school, degree class, involvement in postgraduate education, authoring publications), relevant educational qualifications (a degree eligible for registration into the BPS), relevant vocational experience (a greater number and range of psychology assistant posts), and positive ratings from academic and clinical psychologist experience‐related referees. Short‐listing and selection to clinical psychology training relies on proxy factors related to academic ability, education, vocational experience and ratings from referees. There is little evidence of direct discrimination, although certain subgroups of applicants may be disadvantaged in their opportunities to gain relevant academic qualifications and vocational experience. Copyright © 2004 John Wiley & Sons, Ltd.

Ben‐Ari, Adital; Somer, Eli

doi: 10.1002/cpp.396pmid: N/A

This study explores the ongoing experience of women who were sexually involved with their psychotherapists (therapist–client sex, TCS). Fourteen women who had been engaged in TCS were interviewed to examine the constructed meanings associated with their experiences. Respondents described themselves as having been problem‐saturated, lonely, and victimized by pre‐TCS sexual abuse. Many respondents resolved their TCS betrayal in subsequent therapy. For most interviewees, a significant step towards confronting their painful TCS experience was their initiated agreement to partake in this study. Our data suggest that participants went through a significant personal transformation process that encompassed four main themes: self‐perception; interpersonal relationships; the dilemma of filing a lawsuit; and their motivation to participate in this study. Copyright © 2004 John Wiley & Sons, Ltd.

Gwilliam, Petra; Wells, Adrian; Cartwright‐Hatton, Samantha

doi: 10.1002/cpp.402pmid: N/A

Cognitive models of Obsessive–Compulsive disorder (OCD) have emphasized inflated responsibility (Salkovskis, 1985), thought–action fusion (Rachman, 1993), and metacognitive beliefs (Wells, 1997; Wells & Matthews, 1994), as factors contributing to disorder. The metacognitive model views responsibility as a by‐product of metacognitions that make little additional contribution to OCD, and gives rise to the following hypotheses: (1) responsibility and meta‐cognitive beliefs are positively correlated with obsessive–compulsive symptoms, (2) the relationship between responsibility and obsessive–compulsive symptoms is statistically dependent on meta‐cognition, (3) meta‐cognitions positively correlate with obsessive–compulsive symptoms independently of responsibility. The results supported each of these hypotheses and exploratory analyses were conducted to find the best unique set of predictors among a range of metacognitive dimensions. Metacognitive beliefs concerning need to control thoughts, thought–action fusion, and negative beliefs about cognitive competence emerged as reliable predictors. An additional contribution was made by thought–event fusion in one equation. The results provide support for the meta‐cognitive model. Copyright © 2004 John Wiley & Sons, Ltd.