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People with trichotillomania often have persistent negative beliefs about giving into one’s habit. Central in the present study was the hypothesis that the follow-up effects of cognitive therapy (CT), in which these negative beliefs are directly addressed, are better compared to the follow-up effects of behaviour therapy (BT). Fifty-six trichotillomania patients were randomly assigned to either six sessions CT or BT. Forty-eight completed their treatment. Follow-up measurements took place after a 3 months treatment-free period, and at 12 and 24 months. CT and BT both resulted in clear reductions of trichotillomania symptoms (severity, urge, inability to resist, and negative beliefs) immediately after treatment. There were no differences between the groups. Following the treatment-free period, there was a reoccurrence of symptoms. In contrast to our expectation, we failed to show that CT compared to BT resulted in lower relapse rates after the treatment-free period.

This study investigated implicit self-control dispositions—implicit approach tendencies towards low-caloric food rather than towards high-caloric food—in dieters. Action tendencies were assessed and trained using the Approach-Avoidance Task (AAT). Additionally, positive/negative affective associations [Brief Implicit Association Test (BIAT)], approach/avoidance associations (BIAT), and attentional biases [Dot Probe Task (DPT)] were assessed before and after training. Before training, dieters showed a more negative affective association with high-caloric food than non-dieters (positive/negative BIAT), consistent with the presence of self-control dispositions. On the AAT, all participants, not just dieters, showed more approach of low-caloric food than of high-caloric food. Results of neither the approach/avoidance BIAT nor the DPT showed any indication of implicit self-control dispositions. This study also investigated whether implicit self-control dispositions interfered with AAT training effects. This did not seem to be the case, as action tendencies could be strengthened even further. Moreover, training effects generalized to the DPT.

Background Older adults with panic disorder and agoraphobia (PDA) are underdiagnosed and undertreated, while studies of cognitive‐behavioral therapy (CBT) are lacking. This study compares the effectiveness of CBT for PDA in younger and older adults. Methods A total of 172 patients with PDA (DSM‐IV) received manualized CBT. Primary outcome measures were avoidance behavior (Mobility Inventory Avoidance scale) and agoraphobic cognitions (Agoraphobic Cognitions Questionnaire), with values of the younger (18–60 years) and older (≥60 years) patients being compared using mixed linear models adjusted for baseline inequalities, and predictive effects of chronological age, age at PDA onset and duration of illness (DOI) being examined using multiple linear regressions. Results Attrition rates were 2/31 (6%) for the over‐60s and 31/141 (22%) for the under‐60s group (χ2 = 3.43, df = 1, P = .06). Patients in both age groups improved on all outcome measures with moderate‐to‐large effect sizes. Avoidance behavior had improved significantly more in the 60+ group (F = 4.52, df = 1,134, P = .035), with agoraphobic cognitions showing no age‐related differences. Baseline severity of agoraphobic avoidance and agoraphobic cognitions were the most salient predictors of outcome (range standardized betas 0.59 through 0.76, all P‐values < .001). Apart from a superior reduction of agoraphobic avoidance in the 60+ participants (β = −0.30, P = .037), chronological age was not related to outcome, while in the older patients higher chronological age, late‐onset type and short DOI were linked to superior improvement of agoraphobic avoidance. Conclusions CBT appears feasible for 60+ PDA‐patients, yielding outcomes that are similar and sometimes even superior to those obtained in younger patients.

Five variables were investigated with regard to their possible predictive value for cognitive behavioural treatment (CBT) outcome in a large sample of panic disorder (PD) patients. The variables were initial symptom severity, comorbid anxiety or depressive disorders, comorbid cluster C personality disorders, and initial motivation for treatment. A total number of 161 PD patients received a standardized CBT of 15 sessions. Assessments of predictive variables took place prior to treatment. Outcome measures were assessed at pre- and posttreatment. The patients had significantly improved after the treatment. None of the variables, separately or together, affected CBT outcome, save initial severity of panic disorder symptoms, which was positively associated with posttreatment symptom severity. Since research efforts failed to produce consistent predictors for CBT treatment outcome in panic disorder thus far, the usefulness of future outcome prediction research in panic disorder by pre-treatment demographic, disorder-related, psychological, or socio-psychological variables is put into question.

Abstract Background In psychosis spectrum disorders, maladaptive mental imagery is associated with auditory verbal hallucinations (AVHs). This study evaluates the feasibility, acceptability, and effectiveness of the following 4 imagery techniques in targeting mental imagery and AVHs severity: Imagery Rescripting (ImRs), Promoting positive Imagery de novo (Pos-Im), Metacognitive Imagery techniques (Meta-Im), and playing Tetris. Study Design Four replicated single-case series experimental designs were used. Participants were randomized to 1 of the 4 treatment conditions. Primary, we measured the severity of mental imagery and AVHs thrice daily on an 11-point VAS scale during a 2-week baseline, throughout 3 weeks of therapy, and during a 2-week follow-up phase. Randomization tests were used to examine whether daily severity levels of momentary mental imagery and AVHs decreased post-therapy. Secondary, questionnaires assessing the severity of AVHs, mental imagery characteristics, and levels of mood, anxiety, and functioning were administered at baseline, before, and posttreatment. Results Twenty-eight participants completed all treatment sessions. Mental imagery significantly decreased after ImRs (P < .001, d = 1.13) and Pos-Im (P = .039, d = 0.22), with no significant effects observed following Meta-Im or Tetris. AVHs significantly decreased with all treatment conditions, with largest effects for ImRs (P = .001, d = 1.39) and Pos-Im (P < .001, d = 1.99). Secondary results demonstrated reductions in the severity of AVHs, mood, anxiety, imagery frequency, and appraisals. Conclusions Imagery techniques appear feasible and acceptable for addressing mental imagery and AVHs in the psychosis continuum and may be valuable additions to current treatment for AVHs.

This is the first research into preparation for multicultural clinical psychology practice in Europe. It applies the theory of multicultural counselling competency (MCC) to a case study in the Netherlands. It was hypothesized that cross-cultural practice experience, identification as a cultural minority, and satisfaction with cultural training was associated with MCC. The Multicultural Awareness Knowledge and Skills Survey was completed by 106 participants (22 students, 10 academics, 74 alumni) from clinical psychology masters’ programs. MANOVA detected a main effect of cross-cultural experience on MCC for all groups and universities. The data were enriched with exploratory qualitative data from 14 interviews (5 students, 5 academics, 4 alumni). Interpretative Phenomenological Analysis revealed three themes: limitations of clinical psychology, strategies for culturally competent practice, and strategies for cultural competency development. These outcomes suggest that cultural competency continues to require attention in master’s programs. The paper makes recommendations for further research enquiry related to training clinical psychologists to practice in Europe’s multicultural societies.

Different views exist regarding the nature of patients’ dependency in psychotherapy (trait versus contextual dependency), and its impact on treatment outcome and duration. Therefore we examined whether patients’ levels of care dependency changed over time during a 9-month treatment period, and whether care dependency was related to symptom reduction and patients’ wish for treatment continuation at the end of the treatment. Participants in this longitudinal study were 113 patients (Mage = 33.6, 78% female) with personality disorders receiving inpatient or daycare group psychotherapy. Both increases and decreases on different aspects of care dependency were found over the course of treatment. Decreases in dependency were related to larger symptom reduction, and higher levels of care dependency, especially patients’ lack of perceived alternative options for the current treatment, were related to patients’ stronger wish to continue their treatment. Changes in care dependency during treatment mainly supports the contextual view on patients’ care dependency, and decreasing levels of dependency may have beneficial treatment effects. However, dependency may also lead to prolonged treatment duration. Clinical implications for therapists are presented.

The present study investigated implicit approach-avoidance action tendencies towards snack foods (pictorial Approach-Avoidance Task), implicit approach-avoidance associations (verbal approach-avoidance Single-Target IAT) and affective associations (verbal positive-negative Single-Target IAT) with snack foods in a group of unselected student participants (N = 83). Participants with higher BMI scores had more difficulty to avoid sweet, but not salty snack foods on the Approach-Avoidance Task. Furthermore, as shown by both Single-Target IATs, there were no significant associations between BMI on the one hand and approach-avoidance associations and positive-negative affective associations on the other hand. BMI did show a positive correlation with errors made on all tasks. The results found on the Approach-Avoidance Task suggest that not increased approach, but impaired avoidance of sweet snacks, might be related to increased BMI. However, more research is needed to further disentangle these findings.

To compare the agoraphobic cognitions of younger and older patients suffering from panic disorder with agoraphobia by means of existing questionnaires. Agoraphobic cognitions were assessed using the Agoraphobic Cognitions Questionnaire (ACQ) in 205 patients confirmed with confirmed panic disorder with agoraphobia (Diagnostic and Statistical Manual, Fourth Edition, Text Revision) and analyzed at the item level applying a Bonferroni correction. The 48 patients who were older than 60 years had a significantly lower mean (SD) ACQ total score than their younger counterparts (1.6 [0.5] versus 2.1 [0.6]; t = 5.7, df = 203, p < 0.001), with their scores on the items fear of going crazy, acting foolishly, losing control, passing out, and brain tumors (p < 0.004) being significantly lower. The differential effect at the ACQ item level suggests that some cognitions seem less relevant for agoraphobic panic disorder in later life. Future research should explore whether and which agerelated cognitions are missed in the current questionnaires.

An investigation to determine which prognostic variables are associated with behavioural treatment failure in obsessive-compulsive disorder (OCD). Empirically established prognostic variables measured at the start of treatment may lead to adjusted treatment programmes for these patients. Forty patients, diagnosed with OCD, received a standardised treatment consisting of 18 sessions in vivo exposure and response prevention. Compulsive behaviour (MOCI) and obsessive fear (ADS) were the outcome measures. Prognostic variables included were initial severity of OC complaints, initial level of depression, problem duration, patients' motivation for treatment, quality of the therapeutic relationship, and marital dissatisfaction. Greater initial severity of complaints (P < 0.01), and depression (P = 0.03) predicted poorer outcome for compulsive behaviour. Greater initial severity of complaints (P < 0.01), and the conjoint variables higher level of depression, longer problem duration, poorer motivation for treatment, and dissatisfaction with the therapeutic relationship predicted poorer outcome for obsessive fear (P < 0.01). The complaint-related variables of initial severity, initial depression, and problem duration, and the non-specific treatment variables of patients' motivation and quality of the therapeutic relationship, affect behavioural treatment outcome in OCD.