Mental health interventions in humanitarian settings are informed by existing evidence-based cognitive behavioral interventions and the theoretical frameworks they are based on. This includes key assumptions that trauma exposure is in the past and that the perception of current threat is distorted. While these interventions have some evidence of effectiveness in affected populations, they have been widely criticized for lacking contextual relevance and medicalizing the suffering of people facing ongoing violence, injustice and oppression. We aimed to address this by reviewing the evidence for the core theoretical mechanisms of post-traumatic stress based on the widely used Ehlers and Clark (2000) cognitive model, specifically in the context of war, armed conflict and political violence. We conducted a systematic review with four searches on the core components of the model, using three academic databases. We identified 69 primary studies, which were narratively synthesized by mechanism, research design and age group. Results showed strong evidence for the role of cognitive appraisals, especially for adults, in the development and maintenance of distress. Mixed evidence was identified for emotions, with a role of shame, guilt and fear in traumatic stress, but also broader collective suffering and prolonged terror. Mixed evidence was also found for the role of memory in traumatic stress, with good evidence for a link between multiple and fragmented memories and traumatic stress, but also for higher autobiographical recall. Further mixed evidence was found for behavioral coping strategies, with avoidant coping associated with traumatic stress in some studies but not others. Current exposure was found to have different mechanisms than post-exposure, such as the negative impact of psychological flexibility and social support on mental health in some contexts, and the benefit of appetitive aggression for the mental health of child combatants. Additional mechanisms were identified related to family functioning, social cohesion and socio-political and economic injustice. An adapted socio-cognitive model of continuous traumatic stress for adults and children is proposed, with implications for future research on distinct mechanisms of the model, and greater contextual relevance of humanitarian mental health interventions delivered during war.

Theories of metaphor must account not only for embodied universals but also for systematic sociocultural variation. Although recent scholarship has highlighted the role of context in metaphor production, the extent to which intersecting macro-social variables shape metaphorical source-domain choice remains underexplored. This study therefore tests the hypothesis that metaphorical source-domain selection is systematically associated with group-level social identity by examining how NATIONHOOD is conceptualised in Nigerian presidential discourse and whether these choices correlate with ethnicity, region, and religion. Using CORNIPS, a 65-year diachronic corpus of Nigerian presidential speeches, and hierarchical log-linear analysis, the study finds that ethnicity emerges as the primary predictor of metaphorical choice. Specifically, leaders from the historically dominant Hausa-Fulani group show a marked preference for metaphors of personification and conflict (NATION AS PERSON, NATION AS WAR), while a minority-group leader favours metaphors of inclusion (NATION AS FAMILY). This suggests that these speakers draw on distinct cognitive models, notably NATION-AS-PERSON/ORGANISM-UNDER-THREAT and NATION-AS-KINSHIP to conceptually structure the nation. Although the findings are situated within specific historical and individual contexts, the study nevertheless shows that metaphorical cognition is meaningfully shaped not only by embodied experience but also by social identity, political history and cultural context.

Social anxiety disorder (SAD) is one of the most prevalent co-occurring conditions amongst cognitively unimpaired autistic people. The evidence-based treatment for social anxiety known as cognitive therapy for SAD (CT-SAD) may to an extent be beneficial to autistic people, but adaptations for autistic people are recommended to increase its effectiveness. The present study aimed to co-produce and pilot an adapted SAD treatment protocol for autistic people based on the Clark and Wells (1995) model, including assessing its feasibility and acceptability. A bespoke 12-week CBT online group intervention was created to meet the needs of autistic people with a diagnosis of SAD. The treatment protocol was created collaboratively with autistic people. It was piloted with seven adult participants (three males, four females) with autism or self-identified autism who completed the group intervention targeting SAD symptoms. With regard to feasibility, we met our initial aims of recruiting our intended sample size of a minimum of six participants for the intervention with an attendance rate of at least 80% of sessions. The excellent completion and attendance rates, respectively 100% and 95%, indicate that the intervention was acceptable to our participants. These findings extend previous research and support the continued adaptation of CBT interventions for autistic people. Furthermore, the evidence of feasibility indicates that further study to evaluate the efficacy of this group intervention is warranted.

Key learning aims

1. (1) To reflect on social anxiety, autism and identify ways to improve the delivery of cognitive therapy for autistic people.

2. (2) To identify useful adaptations to cognitive therapy for autistic people.

3. (3) To learn how to deliver group cognitive therapy remotely for autistic people who present with social anxiety.

Within-task actions can provide additional information on student competencies but are challenging to model. This paper explores the potential of using a cognitive model for decision making, the Markov decision process, to provide a mapping between within-task actions and latent traits of interest. Psychometric properties of the model are explored, and simulation studies report on parameter recovery within the context of a simple strategy game. The model is then applied to empirical data from an educational game. Estimates from the model are found to correlate more strongly with posttest results than a partial-credit IRT model based on outcome data alone.

This paper critically reviews literature about design framing to clarify an understanding of what is meant by the construct of a design frame. It describes the origins of the term design frame and characterises three distinct definitions that can be found within the literature. It reviews empirical studies of design framing to highlight definitional confusion between studies. It discusses the significance of Dorst’s propositional model of design frames and juxtaposes design frames with other related constructs. It clarifies ways that the resolution of nomenclature for describing design framing might lead to a more coherent body of empirical research into this topic. It suggests that there is value in developing a better cognitive model of design framing and outlines potential steps towards such a model.

Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social or performance situations. Cognitive models suggest that self-focused cognitive processes play a crucial role in generating and maintaining social anxiety, and that self-focused cognition occurs prior to, during, and following social situations (Clark & Wells, 1995; Rapee & Heimberg, 1997). There is a substantial body of empirical evidence demonstrating that socially anxious individuals engage in self-focused cognition during and following a social or performance situation. A smaller but growing body literature suggests that a similar process occurs prior to such situations, and that these three processes are interdependent. Furthermore, the vast majority of research to date indicates that self-focused cognitive processes are detrimental, and that they generate and maintain social anxiety in a variety of ways. However, there remains considerable scope for research to further explicate the role of these processes in the maintenance of SAD, and to enhance interventions designed to ameliorate their negative effects.

Background: Extreme appraisals of internal states correlate with and prospectively predict mood symptoms in adults, and discriminate individuals with bipolar disorder from individuals with unipolar depression and non-clinical controls. Aims: These findings required replication in adolescents. This study sought to investigate the relationships between appraisals of internal states, mood symptoms and risk for bipolar disorder in an adolescent sample. Method: A non-clinical sample (n = 98) of adolescents completed measures of mood symptoms, appraisals, and mania risk, alongside covariates. Results: Appraisals of internal states were associated with analogue bipolar symptoms, independently of impulsivity and responses to positive affect. Positive appraisals of activated mood states were uniquely associated with hypomania, whilst negative appraisals were uniquely associated with depression and irritability symptoms. Individuals who appraised activated states as both extremely positive and extremely negative were more likely to score at high or moderate risk for future mania. Conclusions: This study is the first to demonstrate associations between appraisals of internal states, analogue mood symptoms and mania risk in adolescents. Clinical implications are discussed.

Background: One of the most common interpersonal reactions to threat and anxiety is to seek reassurance from a trusted person. The Reassurance Seeking Questionnaire (ReSQ) measures several key aspects of reassurance seeking behaviour, including frequency, trust of sources, intensity, carefulness, and the emotional consequences of reassurance seeking. Aims: The current study compares patterns and consequences of reassurance seeking in obsessive-compulsive disorder (OCD) and depression. Method: ReSQ scores were compared for three groups: 32 individuals with OCD, 17 individuals with depression, and 24 healthy comparison participants. Results: We found that individuals with OCD tended to seek reassurance more intensely and employ self-reassurance more frequently than individuals with depression or healthy participants, and that if reassurance was not provided, they tended to feel a greater urge to seek additional reassurance. Conclusions: This study is the first to quantitatively elucidate differences in reassurance seeking between OCD and depression.

Background: Research on post-event processing (PEP), where individuals conduct a post-mortem evaluation of a social situation, has focused primarily on its relationship with social anxiety. Aims: The current study examined: 1) levels of PEP for a standardized event in different anxiety disorders; 2) the relationship between peak anxiety levels during this event and subsequent PEP; and 3) the relationship between PEP and disorder-specific symptom severity. Method: Participants with primary DSM-IV diagnoses of social anxiety disorder (SAD), obsessive compulsive disorder (OCD), panic disorder with/without agoraphobia (PD/A), or generalized anxiety disorder (GAD) completed diagnosis specific symptom measures before attending group cognitive behavioural therapy (CBT) specific to their diagnosis. Participants rated their peak anxiety level during the first group therapy session, and one week later rated PEP in the context of CBT. Results: The results indicated that all anxiety disorder groups showed heightened and equivalent PEP ratings. Peak state anxiety during the first CBT session predicted subsequent level of PEP, irrespective of diagnostic group. PEP ratings were found to be associated with disorder-specific symptom severity in SAD, GAD, and PD/A, but not in OCD. Conclusions: PEP may be a transdiagnostic process with relevance to a broad range of anxiety disorders, not just SAD.

Background: Reassurance seeking is particularly prominent in obsessive-compulsive disorder (OCD) and may be important in OCD maintenance. Aims: This study used a new self-report questionnaire to measure the range of manifestations of reassurance-seeking behaviours, describing their sources from which they seek, frequency, process (how they seek), and consequences (as opposed to triggers and motivations). This study also attempts to identify the degree to which reassurance is specific to OCD as opposed to panic disorder. Method: Reassurance Seeking Questionnaire (ReSQ) was administered to 153 individuals with OCD, 50 individuals with panic disorder with/without agoraphobia, and 52 healthy controls. The reliability and validity of the measure was evaluated and found to be satisfactory. Results: Reassurance seeking was found to be more frequent in both anxiety disorders relative to healthy controls. Individuals diagnosed with OCD were found to seek reassurance more intensely and carefully, and were more likely to employ “self-reassurance” than the other two groups. Conclusions: Further investigation of reassurance will enable better understanding of its role in the maintenance of anxiety disorders in general and OCD in particular.

Background and Aims: The cognitive models indicate that people with social phobia and paranoia share a common fear of others. While we recognize clinical differences, it is likely that some of the same psychological processes contribute to the maintenance of both presentations, yet the nature and extent of these similarities and differences are not yet clearly understood. This study explored threat experiences in people with social phobia and persecutory delusions in order to elucidate these aspects of the respective cognitive models. Method: Accounts of interpersonal threat experiences were examined in nine people with social phobia and nine people with persecutory delusions. Verbatim transcripts were analyzed using thematic analysis. Results: Three major themes emerged from the data: participants’ experience of threat, reactions while under threat, and subsequent reflections. Narrative coherence emerged as a superordinate theme. Typical fear responses were found in both groups, particularly in their reactions to threat. The key differences were in participants’ perceptual experiences, ability to stand back from the threat following the event, and narrative coherence. Conclusions: The findings are discussed in relation to current cognitive models of social phobia and paranoia. Theoretical and clinical implications are drawn out, and highlight the need to examine attentional and metacognitive processes more closely if we are to understand the maintenance of perceived threat in these groups, and means of alleviating associated distress.