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Purpose Given the considerable variation in treatment effectiveness observed across Improving Access to Psychological Therapy (IAPT) services, the purpose of this study is to explore client- and service-related variables that predict successful treatment outcomes and clients’ dropout. Clinician-rated clients’ motivation to change was also explored as a potential predictor for both outcome variables. Design/methodology/approach A convenience sample of 1,135 (F = 752; Mage = 39.4) was collected from three IAPT services in the North West of England. The study adopts a quasi-experimental, observational design. The analysis involves the description of patients’ socio-demographic and clinical characteristics and the development of three outcome prediction models, using hierarchical logistic regression. Findings After adjusting for confounders, employment status and motivation to change as rated by clinicians were predictive of both recovery and reliable improvement. The higher number of IAPT re-referrals was negatively associated with recovery and positively with dropouts. Clients who indicated low motivation to change and received low intensity treatment at their last session presented a higher likelihood to dropout. Research limitations/implications Given that the evaluation of clients’ motivation to change was solely reliant on clinical judgement, as no validated measure was used, further robust research is recommended to draw sensible conclusions. Originality/value This is the first study evaluating clinician-rated motivation to change as a significant predictor of treatment outcomes and dropouts within the IAPT setting. Further research implications are discussed.

Most theoretical models of posttraumatic stress disorder (PTSD) assign an important role to the trauma memory. In particular, trauma memories are proposed to be disorganised and fragmented in those with PTSD (Foa & Riggs, 1993; Ehlers & Clark, 2000). According to these models, the nature of the trauma memory maintains symptoms and consequently needs to be addressed in treatment. The evidence for the role of memory disorganisation in maintaining PTSD symptoms, however, is inconclusive. An alternative proposal is that, rather than the trauma memory itself, it is the individual's beliefs about the trauma memory (i.e. meta-memory) that are important in the maintenance of posttraumatic stress symptoms. This proposal is asserted by the metacognitive model of PTSD (Wells, 2000), where an individual's metacognitive beliefs following a traumatic event motivate them to engage in dysfunctional responses, such as rumination and worry as a thought control strategy. Such responses consequently prevent the normal, adaptive emotional processing of the trauma that is required for symptoms to subside. Empirical evidence supports the role of metacognitive beliefs and maladaptive responses in the maintenance of PTSD. The potential role of meta-memory, however, has not been adequately studied. The current study aimed to compare the relative importance of memory disorganisation and beliefs about the trauma memory (meta-memory) in the prediction of posttraumatic stress symptoms. Analyses were also conducted to determine whether additional factors considered important in the metacognitive model would contribute further to the prediction of PTSD. A sample of 95 student nurses and midwives narrated their memory of the most distressing placement related event they had experienced. A number of questionnaires were also administered, including a measure of beliefs about the trauma memory, which was devised for the current study (the Beliefs about Memory Questionnaire, BAMQ). The reliability and validity of the BAMQ gained preliminary support. Beliefs about the trauma memory, but not memory disorganisation within the trauma narrative, predicted a significant proportion of the variance in posttraumatic stress symptoms after control variables were accounted for. Furthermore, consistent with the metacognitive model of PTSD, the use of rumination was found to mediate the relationship between both positive beliefs about the need for a complete memory of the trauma and negative beliefs about the meaning of gaps in the trauma memory and PTSD symptoms. The interpretation of the findings is limited by the student sample. The study, therefore, needs to be replicated with a clinical population. The findings, however, provide preliminary support for the role of meta-memory in the maintenance of posttraumatic stress symptoms. No evidence to support the role of memory disorganisation in PTSD was found. Consequently, altering the structure of the trauma memory in the treatment of PTSD, for example through exposure therapy, may not be necessary.

Despite the introduction of the workload agreement five years ago, research by The TES last month found that only a tiny minority of teachers (less than 5 per cent) had seen a substantial reduction in their workload. Set aside time to get away from the job and do something totally different so that you can keep things in perspective. Sharing skills saves time, reduces stress and creates a happier working atmosphere.

'The big problem for dogs comes from treats such as cakes and chocolate,' says [Elaine Pendlebury]. 'Chocolate is especially dangerous because it contains theobromine, which can kill dogs.' 'The tail is an important communications device for a dog,' says Pendlebury. 'Different positions and movements mean different things.' Dr John Bradshaw and Dr Sarah Brown of the University of Bristol found that an erect tail indicates confidence and a lowered or possibly wagging tail insecurity. 'Rabbits are selective eaters,' says Pendlebury. 'Like humans, if they are provided with chocolate and cauliflower, they will invariably choose the sweeter option.'

Domestic dogs follow these ancient instincts despite plentiful food, leading to obesity. 'The big problem for dogs comes from treats such as cakes and chocolate,' says [Elaine Pendlebury]. 'The latter is especially dangerous because it contains theobromine, which can kill dogs.' 'The tail is an important communications device for a dog,' says Pendlebury. 'Different positions and movements mean different things.' Dr John Bradshaw and Dr Sarah Brown of the University of Bristol found that an erect tail indicates confidence and a lowered, but possibly wagging, tail insecurity. YES, carrots are acceptable in moderation, as a sweet treat. But any more will make the rabbit fat, which is difficult to correct. Carrots can also produce intestinal problems. Better to stick to leafy carrot tops, hay and root vegetables, which provide fibre and help keep rabbits' teeth down to the correct length. 'Rabbits are selective eaters,' says Pendlebury. 'Like humans, if they are provided with chocolate and cauliflower, they will invariably choose the sweeter option.'

Domestic dogs follow these ancient instincts despite plentiful food, leading to obesity. 'The big problem for dogs comes from treats such as cakes and chocolate,' says [Elaine Pendlebury]. 'The latter is especially dangerous because it contains theobromine, which can kill dogs.' MANY dog owners mistakenly think a dog's foul mouth odour is normal. It's not. Dogs' mouths can smell if they've eaten something unpleasant, but otherwise it is an indicator of poor health -- possibly a sign of dental disease inflaming the gums. 'Rabbits are selective eaters,' says Pendlebury. 'Like humans, if they are provided with chocolate and cauliflower, they will invariably choose the sweeter option.'

Domestic dogs follow these ancient instincts despite plentiful food, leading to obesity. 'The big problem for dogs comes from treats such as cakes and chocolate,' says [Elaine Pendlebury]. 'The latter is especially dangerous because it contains theobromine, which can kill dogs.' 'The tail is an important communications device for a dog,' says Pendlebury. 'Different positions and movements mean different things.' Dr John Bradshaw and Dr Sarah Brown of the University of Bristol found that an erect tail indicates confidence and a lowered tail but possibly wagging tail insecurity. 'Rabbits are selective eaters,' says Pendlebury. 'Like humans, if they are provided with chocolate and cauliflower, they will invariably choose the sweeter option.'

Is it possible to book a night when [MARCO PIERRE WHITE] is running the kitchen? HE DOESN'T actually run the kitchen here, I'm afraid. He's here regularly, but he'll just turn up. [Gordon Ramsay] AT CLARIDGE'S The F-Word star's restaurant in the Mayfair hotel Is it possible to book a night when Gordon is running the kitchen? UNFORTUNATELY, I can't. He's got a really busy schedule, so it's impossible to say where he'll be at any given time. I've been told celebrity chefs do cook in their own restaurants [BRAY Heston Blumenthal] does. It's still his pride and joy. But there are always bits and pieces that he gets called out to. He is around for the majority of the evening services, but obviously it's not something we can confirm 100 per cent. Heston's priority is the restaurant, but on the odd occasion he does have to do other things.