Dysfunctional cognitions such as irrational beliefs (IBs) of Ellis' rational emotive behavior therapy (REBT) model and cognitive distortions (CDs) or cognitive errors from Beck's cognitive behavioral therapy (CBT) model are known to correlate with depressive symptomatology. However, most studies focus on one cognitive theoretical model in predicting psychopathology. The current study examined the relationship between both IBs and CDs in predicting depression. A college-age sample of 507 participants completed the Attitudes and Beliefs Scale-2, the Cognitive Distortions Scale, and the Beck Depression Inventory-II. Half of the sample showed minimal depression, while the remaining sample exhibited mild-moderate (37.4%) to severe (11.1%) depression symptomatology. Through regression analyses, the study aimed to examine whether IBs accounted for more of the variance in depression symptomatology after the effects of CDs were considered. Moreover, it tested whether CDs served as a moderator or mediator between IBs and depression. Each of Ellis' IBs (demandingness, awfulizing, self-downing, and low frustration tolerance) accounted for significantly more variance in depression after the variance of CDs was entered with the IB of self-downing explaining the most variance in depression severity. Moreover, while no moderation effect was found, CDs partially mediated the effect of IBs on depression. Both IBs and CDs contributed unique variance in predicting depression. Findings support the clinical notion that IBs and CDs are associated as well as highlight the clinical utility of both conceptualizations of dysfunctional cognitions in explaining depressive symptomatology. Clinicians might consider that each dysfunctional cognition might not be subject to change if not directly targeted. Rather than choosing to focus exclusively on IBs or CDs underlying negative automatic thoughts, psychotherapeutic efforts might benefit from identifying and challenging both types of dysfunctional cognitions.

Research exploring inferential, especially attributional, thinking supports the theory that paranoia is a defense against low self-esteem. The present study extends this research by examining the place of evaluative beliefs in paranoia and depression. In particular, the study begins to explore the possibility that the defensive function of paranoia is to prevent perceived negative other-self evaluation becoming self-self, as happens in depression, by discrediting others through negative self-other evaluations. A paranoid group (n = 23) a depressive group (n = 22) and a normal control group of (n = 22) are compared on their responses to the Beck Depression Inventory and the Evaluative Beliefs Scale, an 18-item measure of other-self, self-self and self-other negative person evaluations. Results supported and refined this theory. As expected, subjects in both clinical groups perceive significantly more negative other-self evaluation (i.e., threat) than controls, with scores significantly higher for the depressed group. Negative self-self evaluation was highest in the depressives; the paranoid group scores were significantly higher than controls, perhaps implying that the paranoid defense is only partial. Lastly, negative self-other evaluations were significantly higher in the paranoid group; the depressives and controls did not differ.

This review focuses on two aspects of anxiety in the dental setting. The first concerns the processes involved in the maintenance of anxiety. Although patients usually experience much less discomfort than they expect, their anxiety can remain high. The processes discussed here include negative ideation, the probabilistic nature of experience, loss of control over intrusive thoughts, and memory. The second aspect concerns the therapeutic interventions designed to alleviate dental anxiety. A distinction is made between therapies that aim to alter the content of ideation and those that are designed to enhance control over symptoms of anxiety.

A growing proportion of urban youth are at high risk for exposure to extreme acts of crime or violence. This article reviews the literature on the relationship between exposure to crime and violence and the development of post-traumatic stress reactions, as well as current assessment methods which have been used to evaluate children’s and adolescents’ exposure to crime and violence. The need for treatment strategies to deal with this growing problem is discussed as well. Based on research findings an intervention model is presented which uses exposure-based exercises as well as cognitive and behavioral procedures that can be readily implemented by a school counselor in a group format.

This article outlines the rationale and use of cognitive behavior therapy in the treatment of the gastrointestinal symptoms and illness behavior associated with Recurrent Abdominal Pain (RAP), often described as the childhood variant of IBS. It begins with a conceptualization of the social learning perspective of RAP, and then covers the relationship between childhood social learning and adult and childhood illness behavior. Studies that have utilized a cognitive behavior therapy approach for treating adult pain are summarized. Finally, specific cognitive behavior therapy trials for treating RAP, as well as moderators of treatment effectiveness, are discussed.

Derealization and depersonalization and are commonly experienced by individuals with panic disorder. Although interoceptive exposure (IE) is a key therapeutic component in the treatment of panic disorder, there currently are few recognized ways to elicit reactions that successfully mimic dissociative symptoms commonly experienced during panic. We examined the ability of several novel methods that elicit anomalous and confusing perceptual experiences to induce at least moderately intense dissociative reactions in a college student sample (N = 34). Two of the novel procedures (i.e., stripes and hand) and a task previously identified as effectively eliciting dissociative symptoms, strobe light plus three-dimensional (3D) glasses reliably induced derealization/depersonalization reactions. The implications of these findings for further research and the clinical practice of IE in treatment of panic attacks are discussed.

“Multiple chemical sensitivities” has become an increasingly common clinical presentation to physicians, though it is infrequently seen by psychotherapists. This case report describes a 61-year-old woman who presents with a long history of chemical sensitivities, that led to a somatization disorder with debilitating agoraphobia, depression, and marital problems. Features of a variety of anxiety disorders are present, as are metacognitions that required an unusual case conceptualization. A cognitive therapy case conceptualization and treatment are described, which address the highly idiosyncratic clinical presentation of this patient.

In recent years there has been a growing interest in the application of cognitive therapy procedures to clients with personality disorders. In this article it is suggested that the interest in personality disorders is consistent with a renewed interest in the basic concept of personality, and that there is a need for systematic theory regarding the fashion in which consistencies in construal style and interpersonal patterns develop. A number of relevant theoretical developments are briefly summarized and their implications for treatment are explored.

This study evaluated the effects of a Cognitive Experiential Therapy (CET)—in the pastreferred to as Rational Stage Directed Hypnotherapy (RSDH)—Cognitive Restructuring (CR), Hypnosis Only (HO), and a no-treatment control condition on the duodenal ulcer syndrome. CET or RSDH is a systematic, stage-directed therapy that employs hypnosis and the cognitive restructuring of self-defeating cognitive, emotional, physiological, and behavioral tendencies. Seven criterion variables were assessed using two standardized instruments and ques-tionnaire data. The standardized instruments included the Millon Behavioral Health Inventory (MBHI) and the Common Beliefs Survey ID (CBS III).

Twenty-five volunteer duodenal ulcer patients served as subjects for the study. The research design, a 4 X 3 factorial design with repeated measures, consisted of four treatment levels (Control, CR, HO, and RSDH) and three time periods (pretest, posttest, and follow-up) over which the subjects were observed. MANOVA on residualized change scores revealed a significant treatment effect. Univariate effects were observed on the MBHI personality coping styles, CBS III evaluation and locus of control scales, and gastrointestinal disturbance. GET appeared to have an ameliorative effect on psychological factors associated with duodenal ulcer.

Therapists endeavor to be genuine and trustworthy with clients, thus facilitating the establishment and maintenance of a positive therapeutic relationship. Unfortunately, clients sometimes knowingly give false or misleading information, maintain counter therapeutic hidden agendas, and deliberately obscure clinically relevant facts. Such factors likely will obstruct the process of case conceptualization, strain the therapeutic relationship, and result in disagreements about proper interventions. We discuss some of the telltale signs of clients’ untruthfulness, and suggest ways in such cases for therapists to draw upon clients’ behaviors in session to construct useful case formulations. Additionally, we describe a number of interventions that increase the chances of pursuing healthy, appropriate, therapeutic goals, irrespective of clients’ degree of sincerity.

Obsessive-compulsive disorder (OCD) and substance-use disorders (SUDs) co-occur at high rates, which is related to poorer psychosocial outcomes. Prior work suggests that, among veterans in the Veterans Health Administration (VHA), OCD is underdiagnosed and undertreated, which can compound negative effects of OCD and SUD co-occurrence. This study identified patterns of OCD and specific SUD co-occurrence and their effect on mental health and substance-use screening measures and mental healthcare utilization. Using VHA administrative data, we identified veterans with an OCD diagnosis from 2010 to 2016 (N = 38,157); 36.70% also had a SUD diagnosis. Specific SUD rates are alcohol-use disorder, 17.17%; cannabis-use disorder, 5.53%; opioid-use disorder, 3.60%; amphetamine-use disorder, 1.49%; cocaine-use disorder, 3.37%; and tobacco-use disorder, 26.50%. Veterans with co-occurring OCD and SUD used more mental health services throughout the data capture period. Findings suggest that OCD and SUD co-occur at high rates within the VHA, and that this is associated with more burden to the healthcare system. Targeted screening and treatment efforts may help address the needs of this population.

The content and development of schemas and scripts of narcissistic investors are described. These patients view themselves as highly visible, with special talents and destiny, excessive obligation to others, and avoidant of satisfaction. Their investment styles focus on regret, immediate outcomes and the use of recent, salient and irrelevant information. Envy is interpreted as reflecting a market value of the self, reflecting a belief in scarcity of respect and lack of intrinsic value. Developmental analysis indicates threats of abandonment, compensation for earlier inferiority, and family myths of uniqueness. Techniques for challenging narcissistic assumptions and a developmental cognitive treatment of a patient’s schemas and scripts are described.

In 2018, a graduate level student filed a complaint regarding the use of exposure-based therapy for persons with obsessive-compulsive disorder (OCD) experiencing violent obsessions. In the investigation, the licensing board expressed concern about safety of us of exposure and response prevention (ERP) with children and in public venues. The licensing board also struggled with accurate assessment of a clinician's efficacy in following the gold-standard treatment for OCD. Despite extensive research demonstrating ERP is a safe, effective treatment for OCD, stigma against exposure based treatments remain strong, even among clinicians. This commentary article discusses the specific licensing investigation and implications for change throughout the field of psychotherapy.

A number of issues important to the clinical utility of mindfulness require systematic study. These include the most parsimonious definition of mindfulness for clinical purposes, how mindfulness is best described to be most approachable to patients, and the extent to which mindfulness shares common mechanisms with other mind–body programs. The discussion includes a brief review of the transition of mindfulness from traditional into clinical settings as well as the components commonly contained within clinical descriptions of mindfulness. A model based on facility in the use of attention is proposed, and a description of mechanisms by which attentional skill may lead to the recognition of internal associational processes and account for psychological outcomes is given. Using constructs already familiar to patients, an attention-based conception may also be more accessible to patients than more elaborate descriptions and have greater utility in identifying commonalities that mindfulness training may have with other mind–body programs.

Despite their range of reactions, the rejoinders to Lyddon and Weill’s article (in this issue) converge on two fundamental issues facing cognitive psychotherapists in the postmodern era: (1) the relation between human knowing and reality and (2) contrasting constructions of the self. In this article I critically evaluate the various rejoinders with respect to these issues. I also suggest that recent developments in the cognitive sciences parallel the postmodern shift away from modernist dualisms and dichotomies toward a more complex and integrative view of psychological phenomena.

Although the Sheehan Disability Scale (SDS) is one of the most extensively used and tested disability measurements, there has only been one psychometric evaluation of its properties in a Chinese-speaking population. Here, we provide a comprehensive psychometric assessment of the scale in 465 Mandarin-speakers who were accessing information online regarding psychotherapy. Principal component analysis and subsequent confirmatory factor analysis indicated that the SDS is one-dimensional (normed fit index = 0.976, non-normed fit index = 0.97, comparative fit index = 0.98, goodness-of-fit index = 0.967, standardized root mean-square residual = 0.023, root mean-square error of approximation = 0.149). The SDS exhibited excellent internal consistency (α = .89) and moderate test–retest reliability when readministered approximately 8 days later (intraclass correlation coefficient = 0.55). Convergent validity was demonstrated by strong relationships with other measures of functional impairment (FI), while divergent validity was evidenced by fair correlation with a treatment ambivalence measure. Known-groups validity analyses showed that high FI was associated with significantly higher clinical scores of anxiety, depression, and obsessive-compulsive symptoms. Regression analysis indicated that the Depression Anxiety Stress Scale-21 score accounted for 37.6% of variance in FI. Overall, these findings support the reliability and validity of the SDS when used in Chinese treatment-seeking individuals, as well its usefulness as an online screening tool of FI.

Meta-analyses have raised doubts concerning the effectiveness of cognitive methods for treating children’s disorders. This article contends that these doubts stem predominantly from the lack of a basic theoretical model for treating children with cognitive therapy, in contrast with the paradigm existing for adults. In view of the variety of different cognitive techniques used to solve children’s problems, this article presents an adaptation to children of Rosenbaum’s (1993) three types of self-control as a model for reference and comparison: redressive, reformative, and experiential. It is suggested that most children can benefit from cognitive therapy in general and from self-control training in particular. This can occur if treatments are designed in terms of developmental stage, socioeconomic background, and the nature of children’s problems regarding etiology and overcontrolled versus undercontrolled disturbances. This report aims to facilitate the therapist in adapting the appropriate cognitive techniques to the child’s specific behavioral problem, needs, and cognitive style.

Editor’s Note: The following article is a direct transcription of a dialogue that occured at the 1992 World congress of Cognitive Therapy in Toronto. For those of you fortunate enough to be there, I am sure you will agree that it was an exciting event For those of you who could not attend or who want a permanent record, I asked Dr. Beck to submit the following article. The result captures most of the flavor of the actual event and provides an account of Dr. Beck’s latest thinking.

This study tested a self-verification model of social anxiety in the context of relationship formation during the transition to college. Incoming college freshmen (N = 68) completed measures of social anxiety and social self-esteem at the beginning of college and 10 weeks later. Using sociometric ratings completed 10 weeks later, relational victimization appeared to be a unitary construct and not distinct from physical victimization. Participants with low social self-esteem at Time 1 were subsequently seen as victimized, reported disliking spending time at Time 2 with peers who reported liking them, and reported high social anxiety at Time 2 even in the absence of subsequent victimization. The implications of these results for understanding the role of self-verification processes in the maintenance of self-image and social anxiety are discussed.

“The merely descriptive literature of the emotions is one of the most tedious parts of psychology . . . I should as leif read verbal descriptions of the rocks on a New Hampshire farm... they distinguish and refine and specify ad infinitum without ever getting into another logical level whereas the beauty of all truly scientific work is to get to ever deeper levels” (James, 1980, p. 448).

We describe the three stages (exploration, insight, action) of the Hill cognitive-experiential model of dream interpretation, discuss clinical issues related to using dream interpretation in therapy, and provide a brief overview of the research and suggestions for further research.

Obsessive-compulsive disorder (OCD) can be effectively treated by cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). Yet, little is known about the long-term effects of inpatient CBT up to one decade after treatment. Thirty patients who had been treated with 12 weeks of intensive inpatient CBT with ERP were examined 8–10 years after their stay in hospital with regard to obsessive-compulsive symptoms, secondary outcomes, and use of healthcare services. Significant (p < .001) improvements in OC symptoms with medium and large effects compared to baseline on the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) and on the Obsessive-Compulsive Inventory (OCI-R) could still be observed, with 20% of the patients reaching remission status. Continuation of exposure exercises after the inpatient stay was the sole significant factor for improved scores at follow-up. The results suggest that OCD does not necessarily take a chronic course. However, maintenance of exposure training seems to be crucial for sustained improvement.

The Means-Ends Problem Solving task (MEPS) was used to assess the effect of instructional set on means-ends thinking. Half of the vignettes were presented from the perspective of a hypothetical individual and half from the subjects’ own personal perspective. Results showed that subjects instructed to respond from the perspective of the hypothetical other produced less socially appropriate responses when their own perspective was presented first. When the order of instructed perspective was reversed (i.e., hypothetical other first), no differences in response quality or quantity were found. This finding supports the use of the MEPS in its traditional form. Results from a second task (alternative solution generation), designed to assess the effect of priming across different social problem solving-tasks, revealed a facilitative priming effect. Individuals generated more solutions to a problem situation when the previous MEPS vignettes had been in the instructed perspective order of Other-Self. Implications of the study’s findings for a two-stage model of problem solving and clinical assessment are discussed.

This article summarizes clinical aspects of school refusal behavior and school dropout as well as community, school, parent/family, social, personal, and academic success predictors of these problems. In addition, systemic strategies to prevent school refusal behavior and dropout are discussed. These include community-, school-, and parent/family-based strategies that emphasize professional collaboration and support to reduce absenteeism. Furthermore, clinical strategies to prevent school refusal behavior and dropout in individual cases are described. These clinical strategies include photographs, videotaping, structured activities outside the home, booster sessions, and introduction to a new school. Suggestions are also made for youth with chronic school refusal behavior and for addressing full-blown relapse.

The complexities involved in encountering and counseling the “postmodern” self in psychotherapy are illustrated via a single session with a client whose self-presentation and in-session behavior were unusual and perplexing. No conclusions are offered.

Research to date suggests that the best treatment for many mental disorders is provided through the combination of medications and psychotherapy (e.g., Hollon, Thase, & Markowitz, 2002). However, the majority of studies supporting this point have been done utilizing highly restricted, controlled samples that may not accurately reflect the way mental illness is treated in the community. The present study attempted to replicate those findings in an outpatient community clinic. One hundred seventy-four adult clients who presented to a community clinic were rated as to their illness severity at both intake and termination of therapy using the Clinical Global Impression Scale and the Global Assessment of Functioning. These clients were divided into groups based on whether or not they took psychotropic medications at any point during therapy. Results showed that clients who took medications fared no better than clients who did not. These preliminary findings suggest that the combination of medications and psychotherapy may not be as effective in the “real world” as prior studies have implied, and point to the need for further research utilizing community samples.

This article provides an overview of 2 closely linked treatment approaches for the substance abusing client: The Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT). In 1973, Hunt and Azrin created CRA in an attempt to restructure an individual’s “community” so that a sober lifestyle was more rewarding than one dominated by alcohol. One salient CRA premise was that an individual’s substance abuse recovery was heavily influenced by his or her social and occupational environment. Sisson and Azrin (1986) later built upon this premise in their work with a new type of client; the loved one of an alcoholic individual who refused to enter treatment. This program was an early version of CRAFT, which is an intervention that works through a nonusing individual to affect the behavior of a substance abuser. This article provides an empirical review of the evolution of these 2 interventions, including their application to illicit drug using clients. It also outlines the clinical procedures that comprise CRA and CRAFT, and considers future research directions.

Recent research stresses that cognitive and affective processes are implicated in Tourette Syndrome (TS) and might influence treatment. The cognitive-behavioral and psychophysiological (CoPs) approach posits that negative appraisals and maladaptive action-planning elicit negative emotions and behaviors that increase muscular tension and thus the urge to tic in TS. Hence, the CoPs targets cognitive-behavioral and affective processes increasing tension prior to tic onset. This article provides clinically novel information in the implementation and utility of the CoPs approach in a severe case of a young man with TS and a range of comorbidities marked by negative cognitions and emotions as well as planning deficits with a long-term follow-up. He received 14 sessions of CoPs therapy. Tic severity significantly decreased post-treatment with maintenance up to 36-months. The process measure of action-planning improved significantly from pre-treatment to 12-months follow-up. Results support the feasibility and acceptability of the CoPs in treating complex TS cases.

The psychotherapeutic process has long been considered a context for persuasion. The Elaboration Likelihood Model of Persuasion provides an integrative framework from which to examine the process of persuasion in psychotherapy. Various source, message, recipient, and context factors interact in a complex manner to produce attitude change. Two routes to persuasion are presented and their relevance for psychotherapy are discussed. The central route requires more effort and more active cognitive processing on the part of the client, resulting in relatively permanent attitudes that are predictive of subsequent behavior. The peripheral route requires minimal cognitive effort, relying on cues in the situation or rather simple decision rules. Attitudes resulting from this route are relatively temporary and are not predictive of subsequent behavior. Both routes to persuasion are characteristic of the psychotherapeutic process. The role of affect in information processing and methods for encouraging central route processing are discussed.