While around one-fifth of UK secondary school pupils exhibit clinically significant eating pathology, in-school mental health provision does not include interventions to address such eating pathology.

This preliminary qualitative study aimed to explore the views of staff, parents and pupils, on the idea of introducing a school-based brief cognitive behavioural therapy programme for non-underweight eating disorders.

31 pupils, 22 parents and 27 staff participated in 12 focus groups across four schools. The semi-structured interview guide covered topics around the practicalities of a potential eating disorders treatment programme, the acceptability of the intervention, and likelihood of future uptake.

Five over-arching themes and 12 subthemes emerged, reflecting the scale of eating and body image concerns, management limitations, and the importance of prioritising mental health over education. Advantages, challenges, considerations, and solutions were proposed for an in-school eating disorders treatment programme.

These qualitative data show that there is support for an appropriately implemented in-school delivery of brief, evidence-based treatment, demonstrating the potential scope of such an approach to support children and adolescents to receive early help with their eating problems and body image concerns.

Cognitive behavioural therapy (CBT) for eating disorders (EDs) does not yield consistent long-term recovery for all patients, highlighting the need to better understand underlying cognitive mechanisms. Recent work suggests that beliefs about losing control – particularly anticipated catastrophic consequences – may serve as key etiological and maintenance factors.

This study examined whether negative beliefs about losing control predict general ED symptomatology in an undergraduate sample.

Data were drawn from a larger psychometric study on control-related constructs and obsessive-compulsive symptoms. A total of 262 undergraduate participants completed the Beliefs About Losing Control Inventory – Second Edition (BALCI-II), Eating Disorder Examination Questionnaire (EDE-Q 6.0), and Depression, Anxiety and Stress Scale (DASS-21).

Simple linear regression indicated that BALCI-II total scores significantly predicted EDE-Q total scores (adj. R2=.08, F1,260=23.61, p<.001). However, in a hierarchical regression, BALCI-II scores did not account for additional variance in ED symptoms beyond depression (ΔR2=.18, ΔF1,259=.624, p=.43). Subscale analyses showed that fears of losing control leading to overwhelming emotions significantly predicted ED symptoms (β=.22, t259=3.03, p=.006), whereas fears related to madness and dangerous behaviours were not significant predictors.

Beliefs about losing control – especially fears of overwhelming emotions – appear to contribute to ED symptom maintenance. These findings provide initial psychometric support for prior qualitative research and suggest such beliefs may represent a meaningful treatment target within CBT. Future research should investigate causal relationships between these beliefs and ED psychopathology.

Internet-delivered parent-led interventions can be useful for treating anxiety in children and adolescents, and they also help increase access to services while reducing time and cost.

This review aimed to investigate the effects of internet-delivered parent-led interventions on reducing anxiety in children and adolescents.

A search of PubMed, PsycArticles, Cochrane Library, and Google Scholar databases identified 13 studies published between 2013 and 2024, which examined internet-delivered, parent-led interventions targeting anxiety in children.

Internet-delivered parent-led interventions had overall positive effects on reduced anxiety in children and adolescents that could be maintained through follow-up. Interventions directly targeting anxiety symptoms had significant treatment effects.

Internet-delivered parent-led interventions may be effective in reducing anxiety symptoms in children and adolescents, particularly when the intervention directly targets anxiety rather than focusing solely on parenting approaches. Interventions supplemented with therapist support, such as telephone consultations, appear to enhance treatment outcomes and help maintain effects over time. Two-thirds of the included studies had a moderate risk of bias, and one-third had a serious risk of bias. Further studies using rigorous methodologies are needed to strengthen the evidence base.

Cognitive Behavioural Therapy-Ten (CBT-T) offers a briefer manualised approach to treatment of non-underweight eating disorders (EDs) compared with traditional therapy models, and has the potential to help services deliver timely access to care. This study evaluated CBT-T outcomes in a naturalistic setting, with a focus on session-by-session change patterns.

A total of 151 young adults received CBT-T in a no-threshold-to-access community ED service. Symptom trajectories were assessed using the ED-15 global scale and subscales (eating concern, weight/shape concern). Using intent-to-treat principle, linear mixed-effect models evaluated treatment effectiveness, and chi-squared and receiver operating characteristic (ROC) analyses explored associations between early symptom change and end-of-treatment remission.

Treatment led to significant reductions in ED symptoms and psychosocial impairment, with large effect sizes. Reliable improvement in Weight/Shape Concern – but not Eating Concern – on ED-15 at session 4 significantly predicted ED symptom scores below the clinical cut-off at the last session.

CBT-T is effective in reducing ED symptoms in young adults with non-underweight EDs. While engagement and progress prior to session 4 have been used to guide treatment planning, as stated in the treatment manual, only the change in weight/shape concern at session 4 appeared to be strongly predictive of outcome in this sample, whereas change in eating concern did not. Early changes in weight and shape concerns at initial sessions may be informative in predicting treatment outcome. The findings can support the future development of CBT-T and other brief ED interventions.

Panic disorder occurs in 1–3% of adolescents and without treatment often has a chronic course. Treatments need to be effective and efficient to be delivered in routine services. Given that a brief version of cognitive therapy has been shown to be effective in adults, an adapted version could be beneficial for adolescents with panic disorder.

We aimed to establish clinical and economic proof-of-concept for brief cognitive therapy for adolescent panic disorder and examine the feasibility of a future definitive trial compared with a brief generic form of CBT, using several well-defined criteria.

Thirty-four young people (aged 12–17 years) meeting diagnostic criteria for panic disorder and attending a routine clinical service, were randomly allocated to receive either brief cognitive therapy (B-CT) or a brief generic form of CBT; both involved five treatment sessions and up to two booster sessions and were delivered by Children’s Wellbeing Practitioners. We examined patient outcomes, expectations, and experiences, as well as health economic factors post-treatment and at 3-month follow-up. We also explored panic severity 12 months after treatment completion.

The trial met feasibility and acceptability criteria in relation to recruitment and there were no serious concerns around acceptability of treatment and trial procedures.

This study provides preliminary evidence that both B-CT and a generic form of CBT are associated with positive outcomes, expectations, and experiences for adolescents, parents/carers and clinicians. However, there appear to be additional benefits from B-CT that are worthy of evaluation in a future definitive RCT.

Parent depression is a well-established prospective risk factor for adverse offspring mental health. Multiple lines of evidence suggest that improvements in parent depression predicts improved offspring mental health. However, no systematic review has examined the impact on offspring of psychological treatment of purely parent depression after the postnatal period.

To systematically review the literature of randomised controlled trials examining the impact on offspring mental health outcomes of psychological interventions for parental depression after the postnatal period.

We pre-registered our systematic review on PROSPERO (CRD42023408953), and searched the METAPSY database in April 2023 and October 2024, for randomised controlled trials of psychological interventions for adults with depression, which also included a child mental health or wellbeing outcome. We double screened 938 studies for inclusion using the ‘Paper in a Day’ approach. All included studies would be rated using the Cochrane Risk of Bias tool.

We found no studies that met our inclusion criteria.

Robust research into psychological therapy for depression in adults outside the postnatal period has failed to consider the potential benefits for the children of those adults. This is a missed clinical opportunity to evaluate the potential preventive benefits for those children at risk of adverse psychological outcomes, and a missed scientific opportunity to test mechanisms of intergenerational transmission of risk for psychopathology. Seizing the clinical and scientific opportunities would require adult-focused mental health researchers to make inexpensive additions of child mental health outcomes measures to their evaluation projects.

Health anxiety by proxy (HAP) refers to parents’ worries about their child’s health. Research into HAP is in its infancy, but it is known that the children of those with HAP and the broader family system are affected by these elevated health concerns.

This study aimed to explore factors associated with HAP in parents of children with cancer, and parents of ‘well’ children, particularly parental health anxiety (HA), social support, and illness characteristics.

Cross-sectional online questionnaire design using social media and NHS paediatric oncology services to recruit parents of children with cancer (n=41) and parents of ‘well’ children (n=79).

HAP (but not HA) was significantly higher in parents of children with cancer than those with ‘well’ children (p < .001). HAP was negatively associated with social support in parents of ‘well’ children only (p=.002), but both groups demonstrated a positive association between social support and HA (p=.006). Both HA (B=.588; p < .001) and health status of child (B=–30.281; p < .001) were significant independent predictors of HAP (controlling for interactions between group and variables) in a hierarchical regression.

Parents of children with cancer have higher rates of HAP (but not HA), with HAP associated with lower levels of social support in both groups. Parental HA and child health status are key to understanding HAP. Further research is needed to establish underlying mechanisms and vulnerability to HAP to inform development of effective interventions for this group.

Modularised CBT is a promising intervention for childhood anxiety disorders (ADs).

The purpose of this study was to examine whether client feedback informed treatment (FIT) predicts treatment outcome of children with ADs. In addition, the predictive role of therapeutic alliance on treatment outcome was investigated.

Participants were children aged 7–17 years who all received individual modular CBT for their ADs and who were randomly allocated to either feedback informed treatment (FI-mCBT) (n=38) or modular treatment without feedback (mCBT) (n=58). Therapists in FI-mCBT received feedback regarding the child’s anxiety symptoms and treatment satisfaction after each session. Anxiety symptoms were measured with the SCARED-71 at pre-treatment, after five sessions (mid-evaluation), post-treatment, and at 10 weeks follow-up. Alliance was measured with the Working Alliance Inventory and reported by child, therapist and observer.

No differences were found in decreases of anxiety symptoms between FI-mCBT and mCBT over time. Overall, therapeutic alliance did not predict decreases of anxiety symptoms over time. However, child reported therapeutic alliance was positively associated with anxiety symptoms in general. No effects were found for therapist and observer reported alliance.

Our results suggest that providing therapists with feedback does not seem to improve treatment outcome for modular CBT in children with ADs. Therapeutic alliance did not predict treatment outcome in the context of modular CBT.

Cognitive behavioural therapy (CBT) is the first-line treatment for anxiety and related disorders. Limited research has explored long-term outcomes following CBT for anxiety-related disorders in naturalistic settings, particularly for generalized anxiety disorder (GAD), social anxiety disorder (SAD), and post-traumatic stress disorder (PTSD).

This study examined long-term outcomes and attrition after group CBT for GAD, SAD, and PTSD in a naturalistic sample. Across disorders, it was hypothesized that gains would be maintained long-term, with a gradual return of clinically relevant symptoms observed at later follow-up points.

Data were collected from individuals completing CBT at a tertiary anxiety treatment clinic. Symptom changes pre- to post-treatment and over a 2-year follow-up were examined, as well as the influence of baseline depressive symptoms on change over time. Worry, social anxiety, and post-traumatic stress symptoms were assessed at pre- and post-treatment and 3, 6, 9, 12, and 24 months.

On average, symptom improvements were maintained over the 2-year follow-up for all disorders. Higher pre-treatment depression was associated with greater symptom severity throughout the study but generally did not affect the magnitude of symptom change. The exception was PTSD, where baseline depression was also associated with changes in symptom severity across the whole study period. This effect was not observed for those with SAD and GAD. Attrition was high across the follow-up period.

This study provides preliminary evidence for the long-term efficacy of CBT in a naturalistic setting. It also highlights challenges with retaining clients in long-term follow-up in naturalistic settings.

The United Kingdom’s Talking Therapies for Anxiety and Depression (TTAD) programme provides standardised definitions for recovery-related outcomes, allowing transparent and comparable reporting. This study aimed to descriptively examine recovery-related outcomes following cognitive behavioural therapy (CBT) in a Japanese clinical sample using established TTAD definitions.

Data were drawn from patients who received CBT in routine clinical practice. Depressive and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, respectively. Recovery, reliable improvement, and reliable recovery were classified according to the TTAD criteria.

The sample consisted of 241 participants, of whom 178 (73.9%) met the criteria for caseness at baseline. Among those with baseline caseness, 75 participants (42.1%) met the criteria for recovery at the end of treatment. Across the full sample, 103 participants (47.2%) demonstrated reliable improvement. Reliable recovery, defined as meeting the criteria for both recovery and reliable improvement, was observed in 65 participants (36.5% of those with baseline caseness).

Using standardised TTAD definitions, this study provides a descriptive account of recovery-related outcomes following CBT in routine clinical practice in Japan. The findings show the distribution of recovery and improvement outcomes in this sample and highlight the importance of clearly distinguishing between recovery-related indicators when interpreting outcomes in real-world clinical settings.

Intrusive re-experiencing of traumatic events is a cornerstone of post-traumatic stress disorder (PTSD). Clinicians notice that clients also experience intrusive mental images of what they think might happen during a traumatic event. As mental imagery has a powerful impact on emotion, imagination-based imagery may be implicated in the peaks of distress (‘hotspots’) during a trauma.

A data-only study was undertaken of cognitive therapy for PTSD ‘hotspot’ charts used by Grenfell Health and Wellbeing Service clinicians after the Grenfell fire disaster. The aim was to establish the prevalence and nature of peri-traumatic ‘imagination-based hotspots’ in this sample.

Hotspots are described as the worst moments within a trauma. Two clinicians independently rated anonymised hotspot charts (N=26) for the presence and content of ‘imagination-based hotspots’, defined as ‘a peak of emotion during a traumatic event that is related to something imagined “in the mind’s eye” as opposed to directly perceived with the senses’.

81% (N=21) of individuals reported an imagination-based hotspot; 38% of all hotspots (n=159) contained an imagination-based component. The most common was an image in which the person watching the fire imagined themselves in the ‘shoes’ of a tower resident.

Imagination-based mental imagery appears to be linked to the ‘hotspots’ of a high proportion of people experiencing PTSD in this sample. Results underline the importance of enquiring about the presence of mental imagery during PTSD treatment. The presence of peri-traumatic mental images has implications for effective updating of ‘hotspots’ in PTSD treatment.

Since the COVID-19 pandemic, delivering psychotherapy via telehealth has become commonplace, including with dialectical behaviour therapy (DBT); however, there is minimal research examining the difference in engagement between in-person and telehealth DBT. A multi-component intervention, DBT addresses problems associated with emotion dysregulation across a range of diagnoses, including suicidal and self-harming behaviour. Comprehensive DBT includes weekly individual and group sessions, out-of-session skills coaching, and consultation team for therapists. The DBT-Linehan Board of Certification (LBC) certifies DBT programs that demonstrate fidelity to the evidence-based model.

This paper presents data drawn from LBC-certified DBT programs on the delivery of the treatment via telehealth. Primary aims were to determine differences in DBT attendance or non-completion: (1) associated with the transition to telehealth and (2) between clients attending solely in-person vs telehealth.

Data were analysed by cohort: (1) clients who started DBT in-person and transitioned to telehealth; (2) those who were seen solely in-person; and (3) those seen only via telehealth.

There was a lack of significant differences in missed sessions and treatment non-completion when comparing before and after the move to telehealth. Comparing solely in-person to telehealth, significant differences emerged with telehealth demonstrating fewer missed sessions as well as a lower rate of treatment non-completion. No differences were found when comparing adolescent and adult participants.

Implications for telehealth delivery of DBT are provided, along with reflections on the potential impact of client characteristics that can inform future research.

Despite its significant impact on parenting and child outcomes, postnatal anxiety receives less attention than postnatal depression. Intolerance of uncertainty (IU) and inflated responsibility (IR) may be vulnerability factors for postnatal anxiety and infant feeding outcomes. For this reason, we investigated the associations of postnatal anxiety and a range of factors including IR and IU.

Postnatal women (n=126), predominantly white Irish, completed an anonymous online survey assessing postnatal anxiety, IU and IR, and infant feeding. Hierarchical multiple regression analyses were tested for unique predictors of postnatal anxiety. Multivariate tests were used to assess variables associated with feeding outcomes.

Although both IR and IU were significantly correlated with postnatal anxiety, regression analyses found only IR accounted for a significant amount of unique variance in postnatal anxiety. In terms of feeding outcomes, IR and IU were associated with reduced likelihood to breastfeed.

IU and IR may have different impacts on postnatal anxiety. IU and IR may explain the higher incidence of anxiety in postnatal women and impact on a mother’s decision to breastfeed her infant. Although important, these are results of a small cross-sectional study with some limitations. As such, they should be interpreted with caution. More investigation of these concepts would be beneficial.

Best practice guidelines recommend CBT for everyone with psychosis, yet high rates of non-engagement and early drop-out result in many not receiving ‘full dose’ therapy. For those who do engage, effect sizes are typically modest. Most people with psychosis have an insecure attachment style, characterised by predictable and problematic patterns of beliefs, emotion regulation and interpersonal behaviours, including help-seeking. Attachment-congruent adaptations to CBT could improve retention and recovery outcomes for people who are also insecurely attached.

This is the first evaluation of attachment-congruent adaptations to CBT for psychosis. We assessed impact of therapy for the first five people (aged 30–50) to complete therapy and measures.

We used a single case ABC design and measured paranoia, voices, help-seeking, coping, and personal goals over baseline, intervention, and follow-up phases. We predicted that adapted CBT would lead to improved outcomes which would be maintained at follow-up. Trait measures of voices, paranoia, attachment, and recovery are used to describe the sample.

Participants presented with complex needs, including paranoia, voices, and attachment insecurity. Baseline phases showed high and variable levels of psychosis. All showed improvements in paranoia, voices, willingness to seek help, ability to cope, and/or personal recovery goals over the intervention phase. Gains were largely maintained or improved further at follow-up.

Attachment-congruent adaptations to CBT are likely to benefit people with psychosis who present with the additional cognitive, affective and behavioural complexities characteristic of insecure attachment, which threaten access and impact of recommended treatments if not addressed.

The experience of hearing an ‘anorexic voice’ is common amongst those diagnosed with anorexia nervosa and can act as a barrier to recovery. The relationship with the anorexic voice can become coercive and hostile. Relating Therapy promotes assertive responding to the anorexic voice and was previously evaluated over 16 sessions. Consultation with people with lived experience suggested that Relating Therapy should be offered over an extended duration to facilitate the guided application of learning to eating behaviours.

The primary aim of this study was to inform the design of a future trial by exploring the feasibility of evaluating an extended course of Relating Therapy over 24 sessions. A secondary aim focused on the preliminary exploration of signals of change.

A mixed-methods feasibility study used a case series with repeated within-person measures to explore signals of change.

Seven of nine participants completed a course of Relating Therapy. Feasibility outcomes were positively confirmed. Signals of change were evident in relation to a greater ability to engage with important and meaningful aspects of life, a re-defined relationship with the anorexic voice, and reduced distress around eating and body image.

The study generated evidence of the feasibility of evaluating an extended version of Relating Therapy for those who are distressed by an anorexic voice. Qualitative and quantitative data were suggestive of positive changes for some participants. A larger trial is warranted to evaluate the efficacy of Relating Therapy for the anorexic voice.

Community crime against older people is of increasing concern but the relationship between safety-seeking behaviours and continued psychological distress has not been examined. As existing assessment tools have limited validity, we aimed to investigate this by designing a novel person-reported safety-seeking behaviour measure (PRSBM) and conducting preliminary evaluation of its wider applicability.

We collected mixed-methods data from n=100 initially distressed older victims at 3 months post-crime, using the PRSBM. This asked older victims how often they engaged in six behaviours (checking, reassurance-seeking, rumination, avoidance, rituals, hypervigilance), what these were, how often, and how much they had changed since the crime. We measured continued distress using the two-item General Anxiety Disorder and Patient Health Questionnaires. We analysed qualitative behaviour data using codebook thematic analysis, quantitative data on behaviour frequency and change using logistic regression adjusted for gender, age and crime type, and explored the PRSBM psychometric structure using unique variable analysis.

Older victims reported a wide range of safety-seeking behaviours conceptually consistent with their experiences. Some were highly restrictive; others may help maintain independence. The frequency of checking, avoidance, and hypervigilance, and a change in avoidance, were most strongly associated with continued distress. The PRSBM was acceptable, comprehensive, and captured differences and commonalities in safety-seeking.

As older victims identified as avoidant appear at risk of losing their independence, referral for treatment is recommended. The PRSBM appears promising as a research and clinical tool in a range of settings, suggesting further testing in different populations would be worthwhile.

Rumination is a repetitive cognitive process associated with emotional distress and may represent an important preventive target during adolescence.

This study examined the effectiveness of a CBT-based group psychoeducation programme in reducing rumination among adolescents.

A total of 173 eighth-grade students were screened, and 43 adolescents with elevated rumination were enrolled and randomly assigned to experimental, placebo, and control groups; 41 completed the study. A quasi-experimental pre-test–post-test–follow-up design was used.

A mixed-design ANOVA showed significant time, group, and time × group effects. Rumination decreased significantly in the experimental group and was maintained at the 4-week follow-up, whereas no meaningful change was observed in the placebo or control groups.

School-based CBT-oriented psychoeducation may represent a promising preventive approach for adolescents with elevated rumination.