This study uses semi-structured interviews with obsessionals and nonclinical controls to investigate the frequency with which these individuals experience intrusions about possible harm and the frequency with which they then act to prevent that possible harm. The findings suggest that obsessionals do not generally experience more frequent intrusions about possible harm than do nonobsessionals, but that obsessionals more frequently experience intrusions in specific situations: obsession-relevant situations and situations they find most problematic. There was found to be a generalized difference between obsessionals and nonobsessionals in terms of frequency of actions taken to prevent potential harm following intrusions in situations that are obsession-relevant and obsession-irrelevant. The findings suggest that the occurrence of intrusions is just one factor influencing obsessional behaviour.

The psychometric properties of a new scale, the Obsessive CompulsiveInventory (OCI; Foa, Kozak, Salkovskis, Coles, & Amir, 1998), were examinedin a nonclinical student sample. The study was a partial replication of theoriginal validation study by Foa et al. Test-retest reliability, internalconsistency, and convergent validity were examined using a sample of 126undergraduate psychology students. Statistical analyses (Pearson's rand Cronbach's alpha) indicated adequate test-retest reliability forthe full scales and subscales (coefficients ranging from 0.69 to 0.88) andhigh internal consistency (all coefficients exceeding 0.7). Convergentvalidity with the Maudsley Obsessional Compulsive Inventory (MOCI; Hodgson& Rachman, 1977) was adequate for the full scales and for the Washing andChecking subscales (coefficients ranging from 0.61 to 0.75). The OCI is auseful supplement to existing self-report measures of obsessive-compulsivesymptomatology.

Treatment of compulsive hoarding has rarely been described in the literature, apart from standard treatments for obsessive compulsive disorder of which hoarding is thought to be a subset. This paper presents preliminary findings from seven patients treated with cognitive and behavioral interventions derived from Frost and Hartl's (1996) theoretical model of hoarding. Six clients attended 15 group treatment sessions over 20 weeks plus individual home treatment sessions and one client received 20 weekly-sessions of individual treatment only. After 20 weeks, treatment resulted in noticeable improvement in several hoarding symptoms for five of the seven patients, especially reduction in excessive acquisition of possessions, although problems with clutter persisted. Three of four clients who continued in treatment for approximately 1 year showed substantial further improvement, although none felt entirely recovered. Findings are discussed in light of the model of hoarding and possible modifications to treatment to enhance motivation and benefits.

This paper will review the development of nurse therapy in England over a period of 28 years. By examining the data available on the efficacy of nurse therapists and the latest picture of the workforce, derived from a recently conducted survey, consideration will be given to how nurse therapy might develop in the future. In particular, the paper will provide an analysis of dissemination issues.

Mental health problems contribute 23% to the global burden of disease in developed countries (WHO, 1999). In the U.K., recent legislation attempts to address this by modernizing mental health services so that they provide evidence based, accessible and non-discriminatory services for both serious and common mental health problems. Cognitive behaviour therapy (CBT) has a robust evidence base that fits very well with the thrust of policy. However, CBT's delivery systems are rooted in traditional service models, which pay little attention to the growing evidence base for brief and single-strand treatments over complex or multi-strand interventions. Services characterized by 9-5 working, hourly appointments and face-to-face therapy disenfranchise the majority of people who would benefit from CBT. In this paper we argue that the evidence exists for service protocols that promote equity, accessibility and choice and that CBT services should be organized around multiple levels of entry and service delivery rather than the more usual secondary care referral systems.

Longitudinal evaluations were conducted on 61 adults who were referred to aMood Disorders Unit with a history of depression (all index episodesreached criteria for DSM-III-R major depression or dysthymia) and who hadcompleted a cognitive behavioural therapy group either on its own or incombination with an assertion training group. Assessment of personality wasmade using DSM-III-R Axis II personality disorder categories. Thesecategories were aggregated to form three groups: (i) no personalitydisorder; (ii) Cluster B (dramatic-erratic); and(iii) Cluster C (anxious-fearful), and were used to identify responsivenessto treatment and outcome at long-term follow-up. A battery of self-reportmeasures were administered pretreatment, posttreatment and at long-termfollow-up (1–3 years later). Both groups showed significantimprovements in mean scores during treatment and these gains were maintainedover the follow-up period. However, improvement in those patients withoutpersonality disorders was greater at posttreatment and at long-termfollow-up, both in level of depressive symptomatology and proportion ofcases meeting criteria for recovery. The treatment implications of theseresults are discussed.

A single case study of a schema-focused cognitive therapy approach to treatment of a young woman with long-term interpersonal relationship problems and affective instability is described. There have been few accounts of this type of therapy that have incorporated outcome measures. Measures of mood and of schema have been taken throughout treatment and results would appear to offer some support for schema-focused cognitive therapy.

This paper seeks to examine the feasibility of targeting cognitive therapyduring early relapse, using a single case design. Gumley, White and Power(1999) offer a theoretical conceptualization of psychotic relapse based onTeasdale and Barnard's (1993) ICS model of depression. Thisconceptualization aims to provide a means for clinicians and patients toformulate the key psychological factors, which may be responsible for theinitiation, acceleration and maintenance of relapse, thereby enabling thesefactors to be targeted should a relapse be indicated. The interventionreceived by a case illustrated in this paper is derived from the ICSconceptualization of relapse. The intervention has two stages: an initialengagement and formulation phase and, if required, a targeted cognitivetherapy phase. All of the characteristics of traditional cognitive therapyare adhered to, including the use of structure, problem focus, agenda, asocratic style, and collaboration. The paper concludes that there is a needfor further research to provide further evidence of the feasibility andefficacy of this approach.

This is a qualitative study in which the views and opinions of Professor Isaac Marks were sought from various nurse therapists using the loosest of interview schedules. The results are annotated and presented below.

Whilst there is substantial evidence of the efficacy of exposure and response prevention in Obsessive-Compulsive Disorder (OCD), little research has focused on delivering treatment in a more cost-effective way. This study investigated the use of brief treatment of a single 45-minute face-to-face treatment session, followed by eight weekly 15-minute telephone therapy sessions, and a final face-to-face session of 30 minutes. Of the four patients included in this small pilot study, of whom all completed treatment, three clients improved and one client made slight improvement. Given these promising results, further investigation of exposure and response prevention delivered in this way is warranted.

The present study examines the effectiveness of an online standardizedtreatment of posttraumatic stress and pathological grief administeredthrough the Internet. Twenty students who had experienced traumatic lifeevents and showed the symptoms of posttraumatic stress participated in thestudy. They received credit course points for inclusion in theresearch. Treatment consisted of 10 writing sessions (45 minutes each)during a period of 5 weeks. Participants were assessed at pretreatment,posttreatment, and after six weeks (follow-up). The participants improvedstrongly from pre- to post-treatment on posttraumatic stress andpathological grief symptoms and in psychological functioning. Theseimprovements were sustained during the follow-up period. Moreover, 19 ofthe 20 participants were clinically recovered after treatment. The changesin posttraumatic stress symptomatology were compared post hoc to changes incontrol and experimental groups from trials on similarly protocolled butface-to-face treatment of posttraumatic stress.

Motivational interviewing is a client-centered, directive therapeutic style for initiating and facilitating change. Introduced through this journal two decades ago, it has been supported in a series of clinical trials as effective in enhancing behavior change through relatively brief intervention. The author explores parallels between this therapeutic style and the nonviolent “join-up” method of Monty Roberts for training and rehabilitating horses. Both methods emphasize a collaborative rather than adversarial working relationship, seek to enhance intrinsic motivation, and produce positive change in a briefer period of time than traditionally thought to be possible. Both respect the other's autonomy and choice, and move with rather than against resistance. Both seem to enhance the speed and amount of change that follow from behavioral methods.

This paper describes an intervention with a man who has Prader-Willi Syndrome (PWS) and mild learning disabilities in a residential setting. PWS is a chromosomal disorder that is characterized by a wide range of behavioural characteristics including overeating and challenging behaviour. The intervention was based on a range of principles derived from a motivational interviewing approach, which were embedded in a broader behavioural framework that was designed to assist in weight reduction and reduce challenging behaviour. Records of weight and challenging behaviour kept over time suggest that the approach had relatively little impact on overall weight. However, levels of challenging behaviour were reduced quickly and have been maintained at a stable and lower level. Weight has also been maintained at a reasonably constant level without confrontation with staff or excessive restrictions on the individual concerned. Relationships between the individual and staff in the home also improved over the course of the intervention.

This case describes the cognitive-behavioural treatment of a 40-year-old woman with a 22-year history of infrequent fainting episodes. It highlights three features: 1) the potential importance of undiagnosed medical conditions in people presenting for anxiety disorders; 2) a somewhat unusual comorbid diagnosis of Agoraphobia Without History of Panic and Panic Disorder with Agoraphobia; and 3) the importance of modifying attitudes about performance and responsibility to reduce the chance of relapse.

Psychological formulations are central to cognitive behavioural approaches. The use of such formulations presents a number of difficulties when working with clients with psychotic problems. Despite this, sophisticated psychological formulations can be collaboratively developed with psychotic clients. This paper presents one method of developing such formulations through an evolutionary process. Early in the therapeutic process, simple formulations involving straightforward theoretical models are presented, which are systematically elaborated as therapy proceeds. This involves developing, collaboratively with clients, successive layers of formulation. Each of these layers builds on and incorporates the previous one, yet involves an incremental increase in complexity, depth and informational content. The evolutionary process is illustrated with a case example.

“Most people would welcome the chance to make a tenth of thecontribution in any one area”, began Steve Hollon at NeilJacobson's memorial service in Seattle, Washington this pastJune. “If you stop and think of the number of different domains towhich he has made such a contribution, it really just boggles themind. And, at the same time to be so beloved by so many people...Todo so much – with such grace, with such clarity, and with so muchconcern and caring for family, for students, for friends – he wasabsolutely a marvel.”