Improved understanding of the cognitive and behavioural processes underpinning panic disorder (PD) in adolescents could improve identification and treatment.

We investigated whether the processes outlined in Clark’s (1986) cognitive model of PD are observed in adolescents with PD, are specific to PD, and predict symptom severity.

We recruited three groups of adolescents (12–17 years): 34 with a PD diagnosis, 33 with another anxiety disorder excluding PD (‘clinical control’), and 34 scoring below the clinical cut-off on a measure of anxiety symptoms (‘community control’). Participants self-reported on measures of PD symptom severity, catastrophic cognitions, bodily sensation fear, and safety-seeking behaviours.

The PD group reported significantly higher levels of catastrophic cognitions and safety-seeking behaviours than both control groups. They reported significantly higher levels of bodily sensation fear compared with the community but not the clinical control group. All process measures positively predicted PD symptom severity across all groups.

We found evidence of catastrophic cognitions and safety-seeking behaviours as PD-specific processes in adolescents which predict symptom severity. Bodily sensation fear also predicted symptom severity. Findings support Clark’s cognitive model of PD in adolescents and suggest that catastrophic cognitions and safety behaviours may be targets for adolescent PD treatment.

Bipolar disorder (BD) has a significant impact on functioning in the absence of acute mood episodes. This has been associated with subsyndromal symptoms, co-morbidities, and emotional dysregulation. The present study aims to evaluate the acceptability and preliminary efficacy of imagery-based cognitive therapy (ImCT) in a French community setting. We were particularly interested in the link between mental imagery and emotional dysregulation as this may clarify the mechanisms involved in the potential efficacy of the therapy and ultimately improve its relevance.

Ten participants underwent ImCT, with weekly assessments of mood fluctuations, anxiety, and emotional dysregulation conducted over 1 month (i.e. pre-therapy, post-therapy and 1-month follow-up). Recovery, post-traumatic stress symptoms and self-compassion were measured at baseline and post-therapy. Attrition rates and satisfaction were measured.

All participants who completed therapy (n=8) reported high levels of satisfaction. Five of them showed reliable individual improvement on emotion dysregulation scores. At the group level, a significant decrease in mood fluctuation with a large effect size was found post-therapy.

ImCT showed good acceptability among participants who completed the study. Importantly, our study is the first to provide an indication that ImCT may alleviate subsyndromal mood symptoms but also emotional dysregulation in individuals with BD. This latter finding is particularly relevant given the scarcity of validated psychosocial interventions targeting emotional dysregulation in BD.

Mental imagery plays a key role in the onset and maintenance of psychological disorders, and has become the target of psychological interventions for the treatment of several anxiety-related conditions. However, there are currently no transdiagnostic measures designed to assess the varied dimensions of mental imagery relevant to psychopathology.

To develop and validate a new measure assessing the experiences and appraisals of negative mental imagery.

The initial item pool was generated through a comprehensive literature review and interviews with subject-matter experts. An online community sample provided data for the exploratory (n=345) and confirmatory (n=325) factor analyses.

The new 16-item Negative Mental Imagery Questionnaire demonstrated four subscales (Intrusiveness, Controllability, Beliefs about Mental Imagery, and Realness). Reliability and validity were good to excellent for both the full- and sub-scales.

Appraisals of mental imagery captured by the new measure are consistent with previous research on mental imagery and psychopathology.

The COVID-19 pandemic has had a negative impact on the population’s mental health, particularly for individuals with health anxiety (HA) and obsessive compulsive disorder (OCD). This is in conjunction with a significant change in accessibility of face-to-face psychological services which have had to rapidly adapt to the remote delivery of therapy.

Using a single-arm open trial design, the study aimed to evaluate the effectiveness of evidence-based CBT interventions for HA and OCD delivered via a blend of online therapist consultations interspersed with self-study reading materials. A secondary aim was to evaluate remote training workshops provided to therapists.

Therapists attended three half-day remote workshops after which consecutive participants with HA or OCD were assigned to therapists for treatment. Monthly expert supervision was provided. Patients completed routine outcome measures at each session and an idiosyncratic measure of pre-occupation with COVID-19 at pre- and post-treatment.

Significant and comparable improvements were observed on measures of anxiety, depression and social adjustment from pre- to post-treatment in both the HA (n=14) and OCD (n=20) groups. Disorder-specific measures also showed significant improvements after treatment. The HA group showed greater levels of change on the COVID-19-specific questionnaire. The training workshops were well received by therapists, who valued the monthly supervision sessions.

The study provides support for the effectiveness of the online delivery of CBT for HA and OCD supported by the inclusion of additional self-study booklets.

Distressing mental images are common in people with psychosis. The central role of metacognitive difficulties in psychosis suggests that metacognitive interventions with imagery properties could play a central role in managing distressing mental imagery. A brief imagery-based metacognitive intervention was developed to target the control mechanism of distressing mental images in psychosis.

A fixed baseline case series was designed to investigate whether the intervention was acceptable, feasible and effective.

Eight participants who met criteria for a schizophrenia spectrum diagnosis and experienced distressing future-oriented mental images took part in the case series, which consisted of three phases; baseline, intervention, and follow-up. Symptoms of anxiety, depression, persecutory delusions and schemas were assessed pre- and post-intervention, and qualitative feedback was collected at follow-up.

The metacognitive intervention was feasible, acceptable, and rated as highly satisfactory. One participant dropped out at the baseline phase. No adverse events were reported. Positive change scores with a decrease in symptoms were reported for anxiety, depression, persecutory delusions, and schemas. Tau-U analysis showed positive trends and high effect sizes on mental imagery characteristics at follow-up.

Our findings suggest that it is acceptable and feasible to engage people with psychosis in a brief imagery-based metacognitive intervention and that positive change can be achieved. Further studies are needed to replicate and clarify the findings of our study and develop the evidence base for this intervention.

Specific phobia of vomiting (SPOV), also called emetophobia, is a debilitating condition that shares features with several other anxiety disorders and obsessive-compulsive disorder (OCD). Approximately half of sufferers from SPOV do not fully benefit from current treatment modalities.

Bergen 4-day treatment (B4DT) is a highly concentrated form of exposure and response prevention developed for OCD. This case series reports on the first participants undertaking the treatment for SPOV.

Five female participants underwent the B4DT adapted to SPOV. The Specific Phobia of Vomiting Scale (SPOVI) and Emetophobia Questionnaire (EmetQ-13) were administered pre-treatment, post-treatment, and at 3- and 6-month follow-up. Participants were also shown a 27-minute video portraying vomit-related stimuli of increasing intensity at pre- and post-treatment. The time participants managed to watch the video and their subjective anxiety and nausea were assessed at regular intervals. Reliable and clinically significant change were calculated on SPOVI post-treatment and at 6-month follow-up.

Four of the participants achieved clinically significant change and the fifth reliable improvement, and these results were maintained at 6-month follow-up. The participants watched the vomit-related stimuli video for an average of 10 minutes pre-treatment whereas all completed it post-treatment, experiencing considerably less anxiety. These results were maintained at 6-month follow-up.

The B4DT may be a robust and time-effective treatment format for SPOV with low attrition rates, but further research is needed to verify this.

Low-intensity psychological interventions are effective for children and young people (CYP) with mental health difficulties and can help bridge the demand–capacity gap. Despite increasing awareness, training and use of low-intensity psychological interventions, it is not yet understood what is being implemented in clinical practice in the UK and the associated evidence base.

This paper presents two studies; first, a national survey (n=102) of practitioners to identify low-intensity psychological interventions currently delivered in practice and second, an exploration of the availability and the strength of empirical support (characterised as ‘gold’, ‘silver’ and ‘bronze’) of low-intensity CBT interventions for CYP.

The first study found a wide variety of interventions being used across different services; 101/102 respondents reported using routine outcome measures. The second study identified 44 different low-intensity interventions, 28 of which were rated as having gold empirical support. However, only 13 of the gold interventions were considered accessible for practitioners and only two were reported being used in routine practice.

These findings highlight that these interventions have been developed and empirically tested, but many are not easily accessible, highlighting the ‘research–practice’ gap in the provision of low-intensity interventions. There is a need for an increase in standardisation of care and accessibility of gold interventions. This paper hopes to begin the process of creating a hub of low-intensity interventions that are accessible and empirically supported to improve equity of access and outcomes of low-intensity psychological interventions for CYP.

Cognitive therapy for PTSD (CT-PTSD) is an efficacious treatment for children and adolescents with post-traumatic stress disorder (PTSD) following single incident trauma, but there is a lack of evidence relating to this approach for youth with PTSD following exposure to multiple traumatic experiences.

To assess the safety, acceptability and feasibility of CT-PTSD for youth following multiple trauma, and obtain a preliminary estimate of its pre–post effect size.

Nine children and adolescents (aged 8–17 years) with multiple-trauma PTSD were recruited to a case series of CT-PTSD. Participants completed a structured interview and mental health questionnaires at baseline, post-treatment and 6-month follow-up, and measures of treatment credibility, therapeutic alliance, and mechanisms proposed to underpin treatment response. A developmentally adjusted algorithm for diagnosing PTSD was used.

No safety concerns or adverse effects were recorded. Suicidal ideation reduced following treatment. No participants withdrew from treatment or from the study. CT-PTSD was rated as highly credible. Participants reported strong working alliances with their therapists. Data completion was good at post-treatment (n=8), but modest at 6-month follow-up (n=6). Only two participants met criteria for PTSD (developmentally adjusted algorithm) at post-treatment. A large within-subjects treatment effect was observed post-treatment and at follow up for PTSD severity (using self-report questionnaire measures; ds>1.65) and general functioning (CGAS; ds<1.23). Participants showed reduced anxiety and depression symptoms at post-treatment and follow-up (RCADS-C; ds>.57).

These findings suggest that CT-PTSD is a safe, acceptable and feasible treatment for children with multiple-trauma PTSD, which warrants further evaluation.

Firefighters are frequently exposed to traumatic events and stressful environments and are at particularly high risk of depressive symptoms.

The present study aimed to examine the impact of a combined internet-delivered cognitive behavioral therapy (iCBT) and attention bias modification (ABM) intervention to reduce depressive symptoms in firefighters.

The study was a randomized controlled trial carried out in Kunming, China, and involved the recruitment of 138 active firefighters as participants. The intervention lasted for an 8-week duration, during which participants participated in ABM exercises on alternating days and concurrently underwent eight modules of iCBT courses delivered through a smartphone application. Baseline and post-intervention assessments were conducted to evaluate the effects of the intervention.

Results indicated that the combined iCBT and ABM intervention was significantly effective in reducing symptoms of depression compared with the no intervention control group (U=1644, p<0.001, Wilcoxon r=0.280). No significant change was observed in attention bias post-intervention (U=2460, p=0.737, Wilcoxon r=0.039), while a significant increase was observed in attention-bias variability (U=3172, p<0.001, Wilcoxon r=–0.287). This study provides evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters. This study provides conceptual support and preliminary evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters.

One of the most effective treatments for social anxiety disorder (SAD) is cognitive behavioural therapy (CBT). Prior research indicates group cohesion is connected to treatment success in group CBT for SAD (CBGT). Videoconference CBGT delivery is now common following the COVID-19 pandemic; however, research investigating treatment outcomes and group cohesion in videoconference CBGT for SAD is limited.

The present study aimed to compare group cohesion in videoconference CBGT for SAD to group cohesion in both in-person CBGT for SAD and videoconference CBGT for other anxiety and related disorders. A secondary aim was to compare symptom reduction across all three groups.

Patients completed a 12-week CBGT program for SAD in-person (n=28), SAD via videoconference (n=46), or for another anxiety or related disorder via videoconference (n=100). At mid- and post-treatment patients completed the Group Cohesion Scale Revised (GCS-R), and at pre- and post-treatment patients completed the Social Phobia Inventory (SPIN, only in the SAD groups) and the Depression Anxiety Stress Scales (DASS-21).

Over the course of treatment, all three groups showed a significant increase in cohesion and a significant decrease in symptoms (ηp2 ranged from .156 to .562, all p<.001). Furthermore, analyses revealed no significant difference in cohesion scores between groups at both mid- and post-treatment.

These results suggest that videoconference CBGT for SAD is similarly effective in facilitating cohesion and reducing symptoms compared with in-person delivery. Limitations of the study and implications for treatment are discussed.

Cognitive behavioural therapy (CBT) interventions are effective in reducing subjective stress. Nevertheless, the longitudinal links between mental health indicators are rarely studied in intervention research. Therefore, it is unknown how the intervention effects are sustained.

The current study investigated mechanisms explaining sustained intervention effects in a sample of medical nurses who receive a CBT-based internet-delivered stress recovery program.

A single-group longitudinal study design with three measurement points, pre-test, post-test, and 3-month follow-up, was used in the current study. The sample consisted of nurses and assistant nurses from Lithuania (n=111, age: M (SD) = 41.69 years (10.85)) who had participated in a 6-week CBT internet intervention targeting stress recovery. Data were collected as the randomised control trial, the treatment samples were combined, and the data were analysed using cross-lagged panel analysis with four variables representing the psychological well-being and symptoms of stress, anxiety, and depression.

The results revealed that decreased anxiety and increased psychological well-being at post-test predicted reduced stress levels at the 3-month follow-up. In addition, decreased anxiety at post-test predicted decreased depression at follow-up.

Decreased anxiety and increased well-being could explain the sustainability of reduced stress following a CBT-based internet intervention for nurses. The implications of this for research and practice are discussed.

Several psychological models of bipolar disorder propose that certain types of appraisals can lead to increases in manic symptoms.

We tested whether the belief that being ‘high’ is a natural part of one’s personality and correlates with manic symptoms 4 months later when controlling for manic symptoms at baseline.

This was a prospective 4-month follow-up design using self-report measures. Forty people with a diagnosis of bipolar disorder completed a measure of manic symptoms, a measure of appraisals associated with bipolar disorder, and a single-item measure, ‘To what extent do you feel like being “high” is a natural part of your personality?’, at baseline and follow-up.

The single-item measure showed modest stability over time and construct validity in its correlation with a standardised measure of appraisals in bipolar disorder. As predicted, the single-item measure correlated with manic symptoms at follow-up when controlling for manic symptoms at baseline.

The belief that being ‘high’ is a natural part of one’s personality is a potential predictor of manic symptoms. Further research needs to study the potential mediating mechanisms such as activating behaviours, and control for indicators of the bipolar endophenotype.

Although research has highlighted that suicidal imagery (SuiMI) and experiential avoidance (EA) are important in understanding suicidality, there is a need to understand how they potentially interact. Previous research has highlighted that EA potentially leads to increased cognitive intrusions, but it not known whether EA leads to increased SuiMI.

The purpose of this study was to explore the influence of SuiMI and EA on suicidality (i.e. encompassing thoughts, behaviour and suicide attempts). It was hypothesised that greater frequency of SuiMI would be associated with greater EA. It was also hypothesised that greater SuiMI would be associated with greater suicidality, and that EA would moderate this relationship.

Hypotheses were tested by surveying 197 general university students who completed self-report measures that assessed suicide-related mental imagery (i.e. Suicidal Imagery Questionnaire, SIQ), experiential avoidance (i.e. Multi-dimensional Experiential Avoidance Questionnaire, MEAQ) and suicidality (i.e. Suicidal Behaviours Questionnaire-Revised, SBQ-R).

Frequency of SuiMI was positively correlated with the tendency to engage in EA. SuiMI was a significant predictor of both suicidality and EA. Exploratory analysis found that voluntary SuiMI explained greater variance in suicidality than intrusive, involuntary SuiMI, and that SuiMI only predicted EA in low-risk participants and not for those at high risk of suicide. EA did not predict suicidality and it also did not show any moderating effect on the relationship between SuiMI and suicidality.

There is evidence to suggest that suicide-related mental imagery may play an important role in suicide risk and more specifically imagery that is voluntarily engaged with. Future research is needed to explore the different types of imagery in relation to suicidal ideation in populations at higher risk of suicide.

Evidence suggests that death anxiety is a transdiagnostic construct underlying numerous anxiety-related conditions. A previous phase I trial of Overcome Death Anxiety (ODA), a novel online stand-alone psychological intervention to reduce death anxiety, demonstrated preliminary evidence of efficacy and acceptability in a clinical population. However, this trial was limited by a small sample size (n=20).

To further evaluate the efficacy of this intervention in reducing death anxiety in a clinical population, compared with a waitlist control.

This paper describes the protocol of a phase II randomized controlled, unblinded trial of ODA. A total sample of 256 adults living in Australia, diagnosed with an anxiety-related condition, will be recruited. These participants will be randomised to ODA or a waitlist control. Primary outcomes will be measured as changes in scores on death anxiety questionnaires, reflecting treatment efficacy. The secondary outcomes to be measured are depression, anxiety, stress, suicidality, insomnia, and meaning of life, as well as feedback about treatment program acceptability. This trial will assess the efficacy of ODA for reducing death anxiety in a population diagnosed with various anxiety-related conditions, as well as the overall acceptability and tolerability of the intervention.

This study will provide evidence to evaluate the efficacy of ODA in people diagnosed with an anxiety-related condition.

A growing number of studies among adolescents have reported early maladaptive schemas (EMS) to associate with anxiety and depression within non-clinical samples. However, there is a gap of knowledge concerning clinical populations.

The current study’s aim was to explore the potential association between EMS domains and anxiety and depressive symptoms within clinical sample of adolescents.

The current study included 176 adolescent psychiatry out-patients. The EMS domains were measured with the Young Schema Questionnaire-Short Form 2-Extended (YSQ). Their association with anxiety symptoms (the Overall Anxiety Severity and Impairment Scale) and depressive symptoms (the Beck Depression Inventory II) were analysed with general linear models while controlling for significant confounding factors.

Depressive symptoms were associated with three of the four EMS domains: Disconnection and Rejection (η2p=0.047, p=0.005), Impaired Autonomy and Performance (η2p=0.074, p<0.001), and Impaired Limits (η2p=0.053, p=0.003). Anxiety symptoms were associated with two EMS domains: Impaired Autonomy and Performance (η2p=0.046, p=0.005) and Excessive Responsibility and Standards (η2p=0.054, p=0.002).

Various EMS domains were associated with depressive and anxiety symptoms among adolescent out-patients. Further studies are needed on the effect of EMSs on the treatment outcomes for depression and anxiety.