This paper describes two interventions used to treat patients suffering with chronic depression. In the first (Study 1), a group of five sufferers from depression of more than one year's duration who had been unresponsive to, or declined drugs were given cognitive therapy for depression in a group format and followed up for a year afterwards. They were compared with a wait-list group with a similar natural history. The treatment group showed greater improvement than the wait list group and maintained most of their gains at follow-up. In the second (Study 2) four patients also suffering from chronic depression who scored highly on the Hollon Severity Index were treated in a cognitive therapy group over a more extended period (28 weeks) using the approach designed to treat personality disorder. Modest gains were made by some patients. The findings are discussed and suggestions for improvement are made.

One way of trying to minimize the problems arising from long waiting lists for psychological treatment is to see patients for assessment soon after referral, with the aims of making some contact, helping to reduce demoralization, and perhaps providing some practical coping advice. There is some evidence that such procedure may produce better outcomes in subsequent treatment, but also relevant is how people feel about these procedures and whether they meet patients' perceived needs. This paper reports some data on these questions. The data suggest that such an early contact procedure was strongly preferred by patients, but less strongly by therapists, particularly if the therapist treating a patient was not the same person who made the early contact. What patients liked about the early contact seemed to be mainly “non-specific” components such as reduced isolation and increased understanding. As such procedures seem to produce at least as good outcomes, and are preferred by patients, it is suggested that they should be the treatment of choice for clinics with long waiting lists.

Injection phobia is a “specific phobia” (American Psychiatric Association, 1994) in which affected individuals display an atypical physiological response pattern resulting in vasovagal hypotensive fainting on prolonged exposure. Between 50–60% of people with injection phobia report a history of fainting when confronted with their phobic situation. Applied tension has been demonstrated to be an effective therapeutic intervention for blood phobia in which similar vasovagal responses occur (Öst, Fellenius and Stelner, 1991). It has been shown that cognitive factors can prevent engagement with the treatment of phobic disorders. A case meeting DSM-IV criteria for specific phobia, blood-injection-injury type (American Psychiatric Association, 1994) is described. It illustrates that cognitive factors may prevent full compliance with applied tension and that behavioural experimentation is a useful strategy for dealing with such phenomena.

In this paper, an account of auditory hallucinations is outlined, incorporating the phenomena of intrusive thoughts; this is done with reference to the prevailing cognitive models of auditory hallucinations. The account proposes that metacognitive beliefs inconsistent with intrusive thoughts lead to their external attribution as auditory hallucinations, and that such a misattribution is maintained by reducing cognitive dissonance. It is also suggested that the appraisal of the resulting hallucinatory experience elicits behavioural, emotional and physiological responses that may be involved in the maintenance process. The possibility of extending such an account to certain other positive symptoms is discussed, and the theoretical and clinical implications of such an account are considered, and illustrated with a case example. Finally, a number of testable predictions are made.

The limited effectiveness of cognitive behavioural marital therapy (CBMT) for some couples may be due to a failure to achieve generalized changes in behavioural, cognitive or physiological responses during marital interaction. In the present study an intra-subject replication design across five maritally distressed couples assessed changes associated with CMBT in behaviour, cognitions, and physiological arousal during marital communication. These response domains were assessed weekly in both clinic and home settings. Introduction of CBMT was associated with clear reductions in behavioural negativity in both settings for all couples, some variable cognitive changes across couples and settings, but no consistent change in physiological arousal across couples or settings. Physiological responding was asynchronous with behaviour and cognition. Further research is needed on the significance of physiological arousal in marital distress, and the importance of changes in physiological responding during marital interaction to marital therapy outcome.

Twenty-seven pain clinic patients referred for psychological treatment received Eye Movement Desensitization (EMD) as a major part of their treatment. Their progress was monitored using generalized measures with a three month follow-up. All patients responded to EMD in the session. Subsequently, nineteen completed treatment of whom twelve were successful and seven clear failures. Seven dropped out before completing treatment and one result was not clear. Overall the group showed a large decrease in some, but not all, psychological measures. There was some return of symptoms in the group over the three month follow-up. Neural networks are identified as the probable source of theoretical explanations of this procedure.

According to the cognitive theory, obsessional problems occur when the occurrence and/or content of intrusive thoughts are interpreted as a sign of increased personal responsibility for some harmful outcome to oneself or others. The link between normal intrusive thoughts and obsessional thoughts is outlined. Current definitions of “neutralizing” and “responsibility” within the cognitive framework are examined and clarified. Responsibility-driven attempts to control cognitive activity explain obsessional and compulsive phenomena better than generalized deficit models. Recent descriptions of “meta-cognitive” factors in obsessions echo the existing cognitive model and have similar implications. An extension of the cognitive-behavioural model suggests a link between thought suppression and the perception of responsibility and to concerns about failure to act (omissions).

This study explored both the short-term and long-term effectiveness of group anxiety management training. The treatment package employed ran along cognitive-behavioural principles. Consistent with previous evaluations the groups had a significant effect on levels of anxiety and depression as measured by self-report instruments. Participants rated “meeting people with similar problems” and “learning about anxiety” as the two most important therapeutic ingredients. At a follow-up period of greater than two years therapeutic gains, at least in part, seemed to have been maintained.

Panic, social phobia and agoraphobia are common problems, for which cognitive-behavioural interventions are particularly suitable. Walk Free is a comprehensive service for such sufferers, incorporating assessment by psychologists, home visiting, self-help activities, and support groups. It has expanded rapidly within Cardiff, where there are now four Walk Free centres, and it has seen over 300 sufferers over a three-year period.

Space phobia is a well defined rare syndrome, similar but distinct from agoraphobia. Its key distinguishing feature is fear of absent visuospatial support (open spaces) and of falling. In the past, this condition has generally been considered resistant to treatment by exposure in vivo. We report a case of a woman suffering from severe space phobia who received a cognitive-behavioural based treatment package. The gains that she made are described, but overall her condition remained relatively resistant to therapy. We suggest that a degree of caution regarding outcome goals at the start of any similar treatment of this rare disorder is wise.

Recent research has revealed that relapse in manic depressive psychosis and schizophrenia is preceded by specific prodromal signs and symptoms that include dysphoria, other non-psychotic symptoms and features unique to individual patients. Treatment studies in schizophrenia have shown that early pharmacological intervention during a prodromal phase of psychotic relapse may be effective in the prevention of hospitalization. This paper describes the procedure of prodromal signs identification in manic depressive psychosis and the negotiation of an appropriate plan of action with the mental health services in order to abort the relapse or reduce its severity through early pharmacological intervention. A case example is presented to demonstrate this approach.

A meta-cognitive classification and analysis of factors contributing to the development of problematic worry is presented. Dimensions of meta-beliefs, meta-worry, cognitive consciousness, and strategies can be distinguished. A cognitive model of Generalized Anxiety Disorder is advanced based on this framework in which GAD results from an interaction between the motivated use of worry as a coping strategy, negative appraisal of worry, and worry control attempts. These factors result from combinations of dysfunctional meta-beliefs and contribute to subjectively diminished cognitive control. The model presents new implications for a cognitive therapy of GAD, and these are illustrated with a single case treatment study.