There is an increasing awareness of the limitations of Cognitive Behavioural Therapy for psychosis (CBTp) and researchers are attempting to advance its efficacy. The first part of this thesis was a systematic review of the new CBT approaches for positive symptoms. The evidence for their efficacy was summarised and then examined from a methodological perspective. A search of the literature since 2003 produced sixteen studies, falling into two main strands: an interventionist causal model approach, with studies indicating the potential for greater effect sizes for both persecutory delusions and auditory hallucinations; and 'third wave' CBT, with mindfulness and acceptance-based approaches demonstrating limited benefits for auditory hallucinations. The new developments are potentially a step forward from standard CBTp and implications for future research are discussed. Multiple factors have been identified in the development of persecutory thinking. The second part of this thesis specifically focused on interpersonal sensitivity as a hypothesised causal factor of persecutory delusions, in line with the interventionist causal model approach referred to above. The study evaluated the impact of a newly-devised cognitive behavioural intervention for interpersonal sensitivity (CBT-IPS) for patients with persecutory delusions. The therapy was tested in an uncontrolled pilot study, which included a 2-week baseline period and I-month follow-up. CBT-IPS did not depend on disputing the validity of delusional beliefs• but on reducing concerns regarding criticism or rejection. Eleven participants with persecutory delusions and a psychosis diagnosis completed the 6-session CBT-IPS intervention. Results indicated statistically significant reductions with large effect sizes for both interpersonal sensitivity and persecutory delusions, consistent with the hypothesised causal role. Participants also reported a significant decline in negative beliefs about others. All gains were maintained at follow-up. This was the first test of CBT-IPS and it shows promise as a therapeutic intervention. The next step is to conduct a randomised controlled trial.

Formulation is argued to be of central importance in most psychotherapeutic approaches. Yet, despite the many claims made about its benefits, it remains an under-researched area. Formulation in Cognitive Analytic Therapy (CAT) is known as 'reformulation' and involves both a diagrammatic and narrative component. The diagrammatic component, called the Sequential Diagrammatic Reformulation (SDR), is a key element of CAT. Previous research addressing the impact of formulation suggests that quantitative methodologies are not suited to capturing the complexity of the experience of reformulation. Recent qualitative studies have started to address this gap, but there is still a paucity of research focussed solely on the use of the SDR, in particular little attention has been paid to the perspectives of both clients and their therapists. The present study aimed to address these gaps by conducting an in-depth exploration of clients' and therapists' experiences of using SDRs in CAT. Seven participants, comprising four clients and three therapists, were interviewed. The data was analysed using Interpretative Phenomenological Analysis (IPA). Six master themes emerged that represented how the SDR had impacted on the clients' journeys through therapy: 'Increases understanding', 'Facilitates conversations', 'Collaboration', 'Facilitates change', 'Impact of the SDR beyond therapy', and 'Doing it right'. The analysis revealed many similarities between the clients' and therapists' accounts. This study supports the hypothesised benefits of the SDR and helps to further our understanding of the processes by which these are achieved. The results have clinical implications, which suggest ways in which therapists can maximise the potential benefits of the SDR. Future research is needed to validate these findings and investigate whether the experiences of these participants can be generalised to other CAT therapists and clients.

Mindfulness-based Cognitive Therapy (MBCT) is an 8-week meditation-based group intervention program developed for preventing depressive relapse in people with recurrent depression. While recent studies have supported the efficacy of the therapy, there is a lack of data to support the mechanisms presented by theory. The thesis attempted to investigate MBCTs change processes through exploring patient's experiences during the program, their reflections after the course, and to assess practice, process, and outcome changes in the longer term. The thesis included six studies that used a triangulation of methodologies in an attempt to identify and measure MBCT change processes and assess whether they were associated with reductions in depressive symptoms and staying well in the long term. Findings from a qualitative analysis identified eight main themes that 11 MBCT patients felt had helped to bring about positive change following participation in MBCT, namely awareness, attention, skilful action, control, acceptance, group, difficulties, and transformation. A further study assessed change following participation in MBCT for 40 patients and showed reductions in depressive symptoms which were associated with increased self-compassion, self-kindness, common humanity, reversed over identification, mindfulness, nonjudging of inner experience, nonreactivity to inner experience, self-control, monitoring and control of mood, attributional style, goal setting, and reduced devaluative views of the self. A long term study investigated the effects of MBCT for 36 MBCT patients across 52 months after attending the programme. There was evidence to suggest that participants maintained meditation practice up to a 52 months follow up, that there was a decrease in depressive symptoms and this was associated with increased self-compassion, mindfulness, decreased devaluative views of the self, and a decreased tendency to experience a depressive episode. Participants who stayed well and did not experience a relapse were more likely to reportiess self•judgment, less over identification, and decreased devaluative views of the self. These findings offer preliminary support for some of the MBCT change processes that were assessed.

This review aims to examine literature on psychological interventions in the adult acute inpatient settings, with a particular focus on Cognitive Behavioural Therapy (CBT) groups. It outlines the challenges in creating a therapeutic environment on acute psychiatric wards and presents CBT groups developed and introduced in various services across the UK. It is clear that standard interventions, as available in outpatient settings, cannot be applied in the acute units. CBT groups on the wards prove to be popular among clients and staff. They are also seen as meaningful by clinical psychologists. However, popularity is not considered as the same as clinical effectiveness, and so there is a need for more research in this area.

This portfolio contains work which was submitted as part of the Practitioner Doctorate (PsychD) in Psychotherapeutic and Counselling Psychology at the University of Surrey.1t consists of three dossiers which reflect the academic, clinical and research work undertaken as part of this degree. The academic dossier contains three essays. The first essay explores a Winnicottian perspective on how depression can be conceptualised and worked with therapeutically. The second essay examines the variation within the CBT tradition with respect to how emotion is attended to and worked with in clinical practice. With specific reference to depression, the third essay explores the possibility of a second-wave CBT approach to practice that would be more compatible with the principles of counselling psychology than the standard CBT treatments which have adopted the medical model of distress. The therapeutic practice d6ssier gives an overview of my clinical practice during my training. This dossier contains descriptions of the clinical placements I have undertaken, and also includes my final clinical paper which provides a reflective account of my journey toward becoming a counselling psychologist. Finally, the research dossier contains a literature review and two empirical research studies. The review explores the historical context of contemporary theory of emotion within psychotherapy, by examining the theories of emotion within influential philosophical works from the history of Western thought. The first empirical piece is a Foucauldian discourse analysis of how emotion is constructed in contemporary CBT self-help literature. The second empirical piece is a conversation analysis of the recordings of therapy sessions conducted by A. T. Beck, seeking to illuminate how emotion is dealt with in the practice of Beckian cognitive therapy.

Over 500 studies have shown that intergroup contact is an effective and robust way of reducing prejudice. Recent research has extended the power and scope of contact theory further, demonstrating that the simple act of imagining a positive intergroup encounter can promote more positive intergroup relations. In 14 experiments this thesis investigates the moderating potential and underlying mechanisms of imagined contact, and related cognitive processes associated with recalled contact experiences. The first part of the thesis establishes the compensatory power of imagined contact in mitigating the detrimental effects of high intergroup anxiety and low prior outgroup contact on intergroup attitudes, intentions and behavioural tendencies. Furthermore, individual differences in the ability to generate vivid mental images moderate the effectiveness of the approach. In the second part I draw upon established principles in psychotherapy. Imagining a negative contact experience with an outgroup member before a positive one resulted in larger reductions in intergroup anxiety, and stronger future contact intentions, than two positive contact experiences. In the third part I extend the imagined contact research to the domains of memory and cognition. Recall of a positive contact experience enhanced positive outgroup evaluations and contact self-efficacy via reduced o '-_:.anxiety. Consistent with the ease-of-retrieval effect, recalling aO-Iarger--uumber of . contact memories was more difficult for individuals low in prior outgroup contact, leading to lower contact self-efficacy, whereas this was not the case for participants ~~~-~ who had had high levels of prior outgroup contact. I conclude that cognitive interventions, especially those that make use of mental imagery and its special link to emotions, are highly valuable techniques for educators and policy makers in preparing individuals for direct contact, increasing the likelihood of achieving long- lasting harmony in intergroup relations.

No description available.

Imagery rescripting (IR) is a cognitive-behavioural technique that helps patients to modify the meaning they have attached to negative or traumatic experiences. Although it is effective in addressing memory-related intrusive images and in alleviating disorder-specific symptoms, there is little evidence as to how it works. The aim of this PhD project was to investigate the cognitive changes it promotes. Studies 1 and 2 found that memory recall influences individuals’ sense of self. They report higher state self-esteem, fewer achievement goals, and more recreation/exploration goals after recalling positive memories than after recalling negative ones. They also report more emotional self-cognitions after recalling memories from which they have learnt lessons compared to recalling memories from which they have not abstracted any meaning. Studies 3 and 4 found that exposure and IR may influence individuals’ perception of negative memories and the impact these memories have on them when recalled. After being exposed to such memories and after rescripting them, they perceive these memories as less negative and important for their sense of self. They also report higher state self-esteem and either a weaker or a more positive emotional response after recalling them. The findings suggest that memory recall triggers the activation of different self-representations and that IR may influence this process. By helping individuals modify the meaning they have attached to negative memories, IR may facilitate the integration of these memories within the sense of self. This may make the memories and associated self-representations less salient and less likely to be activated in the presence of distressing stimuli. The implications of these findings for imagery research and clinical practice are discussed.

‘FRIENDS for Life’ is a manualised, 10 week, Cognitive Behavioural Therapy (CBT) based programme designed to be run in school and community settings (Barrett, 2010b). The programme has been introduced to schools within the local authority where the researcher is based via the local Targeted Mental Health in Schools (TAMHS) project. The programme is well reviewed and is recommended by the World Health Organisation for the treatment of anxiety disorders in children (World Health Organisation, 2004). Previous research has evaluated the programme when delivered in closely monitored situations with optimal implementation. The aim of this study is to evaluate the impact of FRIENDS for Life as implemented in a mainstream secondary school by school staff trained as part of the TAMHS initiative. This study makes an original contribution to the existing research base by evaluating the programme in a naturalistic, real world setting using an alternative methodology to the majority of published evaluations. Data regarding implementation of the programme was collected and analysed using activity theory. A single case experimental design was used to monitor the impact of the intervention on the emotional distress, anxiety levels and coping strategies of 5 secondary school participants (aged 11-13) who had been identified by school staff as appearing anxious. The findings suggest that participation in FRIENDS did not result in the hypothesised reductions in emotional distress, anxiety and negative coping skills or the hypothesised improvement in active coping skills. These results are discussed with regard to the finding that some aspects of the programme were not delivered. Analysis of the context using activity theory suggested that factors such as lack of time, space for delivery and experience and training impacted upon implementation. Methodological issues contributing to these findings are considered and implications for the local TAMHS project and for Educational Psychologists are discussed.

The need to provide effective Cognitive Behavioural Therapy (CBT) treatments in routine clinical practice necessitates effective methods of CBT training, which are scalable and can be disseminated in populations without ready access to specialist trainers or large scale funding. This thesis seeks to add theoretical and empirical guidance to the development of evidence-based CBT training. The first chapter reviews the current literature on effective CBT training, and suggests theoretical and methodological guidance for future research on evidence-based training practices. Cohort studies (Chapters 2 – 4) examine data from former trainees for guidance on accurate CBT competence measurement and effective CBT training components. The fifth and sixth chapters report randomised-controlled trials examining the effects of internet-based training (IBT) on therapists’ competence and patient outcomes (Chapter 6). Findings from the literature review (Chapter 1) and Chapter 2 suggested the need for training effectiveness trials using treatment trial methodology, which includes ‘blind’ observer ratings of therapist behaviour as the measure of competence. Chapter 3 found that extensive training led to significant improvement in competence for trainees with a range of individual baseline characteristics. Since such extensive training is not accessible to the majority of practicing therapists, Chapter 4 examined which elements of extensive training were perceived by trainees as having the greatest positive effect on competence; thus providing empirical guidance in planning more scalable forms of training, such as IBT. Findings from the first four chapters provided guidance in planning the two randomised controlled trials outlined in Chapters 5 and 6, resulting in rigorous empirical data showing significant positive effects of IBT on therapists’ competence and on their patients’ clinical outcomes. Finally, the results of this thesis are related to the framework for developing evidence-based training, which was suggested in Chapter 1 and suggestions for future research are made.