Development and psychometric evaluation of the Assessment of Core CBT Skills (ACCS): An observation-based tool for assessing cognitive behavioral therapy competence.

This article outlines the development and psychometric evaluation of the Assessment of Core CBT Skills (ACCS) rating scale. The ACCS aims to provide a novel assessment framework to deliver formative and summative feedback regarding therapists' performance within observed cognitive-behavioral treatment sessions, and for therapists to rate and reflect on their own performance. Findings from 3 studies are outlined: (a) a feedback study (n = 66) examining content validity, face validity and usability; (b) a focus group (n = 9) evaluating usability and utility; and (c) an evaluation of the psychometric properties of the ACCS in real world cognitive behavioral therapy (CBT) training and routine clinical practice contexts. Results suggest that the ACCS has good face validity, content validity, and usability and provides a user-friendly tool that is useful for promoting self-reflection and providing formative feedback. Scores on both the self and assessor-rated versions of the ACCS demonstrate good internal consistency, interrater reliability, and discriminant validity. In addition, ACCS scores were found to be correlated with, but distinct from, the Revised Cognitive Therapy Scale (CTS-R) and were comparable to CTS-R scores in terms of internal consistency and discriminant validity. In addition, the ACCS may have advantages over the CTS-R in terms of interrater reliability of scores. The studies also provided insight into areas for refinement and a number of modifications were undertaken to improve the scale. In summary, the ACCS is an appropriate and useful measure of CBT competence that can be used to promote self-reflection and provide therapists with formative and summative feedback. (PsycINFO Database Record

'Flash-forwards' and suicidal ideation: A prospective investigation of mental imagery, entrapment and defeat in a cohort from the Hong Kong Mental Morbidity Survey.

'Flash-forwards' - mental images of suicide - have been reported in selected Caucasian samples. Perceptions of defeat and entrapment are considered to be associated with suicidal ideation. We aimed to investigate (1) the presence of suicidal flash-forwards in people with recent suicidal ideation versus those without such ideation in an Asian sample, and (2) associations between suicidal flash-forwards, and perceptions of entrapment accounting for suicidal ideation. Eighty two suicidal and 80 non-suicidal participants from the Hong Kong Mental Morbidity Survey completed questionnaires including suicidal ideation, presence of suicidal flash-forward images, defeat and entrapment, at baseline and seven weeks later. Suicidal 'flash-forwards' were present only in suicidal cases. People with recent suicidal ideation and suicidal flash-forwards had more severe suicidal ideation than those without flash-forwards. Compared to those without suicidal ideation, people with recent suicidal ideation reported higher entrapment and defeat levels. Resolution of suicidal ideation over time was associated with fewer suicidal flash-forwards and reduced entrapment perceptions. At baseline and seven weeks, suicidal ideation was predicted by an interaction between suicidal flash-forwards presence and perceptions of entrapment. Mental imagery of suicide appears to be associated with suicidal ideation, and may represent a novel target in suicidal risk assessment and prevention.

Is supervision necessary? Examining the effects of internet-based CBT training with and without supervision.

OBJECTIVE: To investigate the effect of Internet-based training (IBT), with and without supervision, on therapists' (N = 61) cognitive-behavioral therapy (CBT) skills in routine clinical practice. METHOD: Participants were randomized into 3 conditions: (1) Internet-based training with use of a consultation worksheet (IBT-CW); (2) Internet-based training with CBT supervision via Skype (IBT-S); and (3) "delayed-training" controls (DTs), who did not receive the training until all data collection was completed. The IBT participants received access to training over a period of 3 months. CBT skills were evaluated at pre-, mid- and posttraining/wait using assessor competence ratings of recorded therapy sessions. RESULTS: Hierarchical linear analysis revealed that the IBT-S participants had significantly greater CBT competence at posttraining than did IBT-CW and DT participants at both the mid- and posttraining/wait assessment points. There were no significant differences between IBT-CW and the delayed (no)-training DTs. CONCLUSIONS: IBT programs that include supervision may be a scalable and effective method of disseminating CBT into routine clinical practice, particularly for populations without ready access to more-traditional "live" methods of training. There was no evidence for a significant effect of IBT without supervision over a nontraining control, suggesting that merely providing access to IBT programs may not be an effective method of disseminating CBT to routine clinical practice.

Bipolar risk and mental imagery susceptibility in a representative sample of Chinese adults residing in the community.

BACKGROUND: We need to better understand the cognitive factors associated with risk for bipolar disorders. Recent research suggests that increased susceptibility to mental imagery may be one such factor. However, since this research was primarily conducted with Western students and at a single time-point, it is not known whether the relationship between imagery susceptibility and bipolar symptoms exists across cultures or within the general community, or whether this relationship remains stable over time. AIM: This study evaluated whether Chinese adults identified as being at high (HR) versus low (LR) risk of developing bipolar disorders showed greater mental imagery susceptibility. We aimed to test whether such a relationship was stable over time by measuring imagery characteristics at baseline and at the 7-week follow-up. METHOD: This prospective study recruited a community sample of N = 80 Chinese adults screened for the absence of neurotic and psychotic disorders. The sample was split into HR (n = 18) and LR (n = 62) groups at baseline based on a criterion cut-off score on a measure of hypomania, the Mood Disorder Questionnaire (MDQ). Participants completed measures of imagery susceptibility and its impact: the Spontaneous Use of Imagery Scale (SUIS) and the Impact of Future Events Scale (IFES), at baseline and 7 weeks later. RESULTS: HR group reported greater tendency to use imagery in daily life (SUIS) and greater emotional impact of prospective imagery (IFES) than LR group at baseline. These results remained stable at follow-up. CONCLUSION: This study provides preliminary evidence for increased susceptibility to mental imagery in individuals at high risk of bipolar disorders recruited from a community sample of Chinese adults. This extends previous research in Western student samples suggesting that imagery (both levels of use and its emotional impact) may be a cognitive factor with cross-cultural relevance that is stable over time.

Assessing Competence in Collaborative Case Conceptualization: Development and Preliminary Psychometric Properties of the Collaborative Case Conceptualization Rating Scale (CCC-RS).

BACKGROUND: Case conceptualization is assumed to be an important element in cognitive-behavioural therapy (CBT) because it describes and explains clients' presentations in ways that inform intervention. However, we do not have a good measure of competence in CBT case conceptualization that can be used to guide training and elucidate mechanisms. AIMS: The current study addresses this gap by describing the development and preliminary psychometric properties of the Collaborative Case Conceptualization - Rating Scale (CCC-RS; Padesky et al., 2011). The CCC-RS was developed in accordance with the model posited by Kuyken et al. (2009). METHOD: Data for this study (N = 40) were derived from a larger trial (Wiles et al., 2013) with adults suffering from resistant depression. Internal consistency and inter-rater reliability were calculated. Further, and as a partial test of the scale's validity, Pearson's correlation coefficients were obtained for scores on the CCC-RS and key scales from the Cognitive Therapy Scale - Revised (CTS-R; Blackburn et al., 2001). RESULTS: The CCC-RS showed excellent internal consistency (α = .94), split-half (.82) and inter-rater reliabilities (ICC =.84). Total scores on the CCC-RS were significantly correlated with scores on the CTS-R (r = .54, p < .01). Moreover, the Collaboration subscale of the CCC-RS was significantly correlated (r = .44) with its counterpart of the CTS-R in a theoretically predictable manner. CONCLUSIONS: These preliminary results indicate that the CCC-RS is a reliable measure with adequate face, content and convergent validity. Further research is needed to replicate and extend the current findings to other facets of validity.

Expert Insight into the Assessment of Competence in Cognitive-Behavioural Therapy: A Qualitative Exploration of Experts' Experiences, Opinions and Recommendations.

UNLABELLED: To offer insight into how cognitive-behavioural therapy (CBT) competence is defined, measured and evaluated and to highlight ways in which the assessment of CBT competence could be further improved, the current study utilizes a qualitative methodology to examine CBT experts' (N = 19) experiences of conceptualizing and assessing the competence of CBT therapists. Semi-structured interviews were used to explore participants' experiences of assessing the competence of CBT therapists. Interview transcripts were then analysed using interpretative phenomenological analysis in order to identify commonalities and differences in the way CBT competence is evaluated. Four superordinate themes were identified: (i) what to assess, the complex and fuzzy concept of CBT competence; (ii) how to assess CBT competence, selecting from the toolbox of assessment methods; (iii) who is best placed to assess CBT competence, expertise and independence; and (iv) pitfalls, identifying and overcoming assessment biases. Priorities for future research and ways in which the assessment of CBT competence could be further improved are discussed in light of these findings. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: A qualitative exploration of experts' experiences, opinions and recommendations for assessing the competence of CBT therapists. Semi-structured interviews were conducted and analysed using interpretive phenomenological analysis. Themes identified shed light on (i) what to assess; (ii) how to assess; (iii) who is best placed to assess; and (iv) common pitfalls. Priorities for future research and ways in which the assessment of CBT competence could be further improved are discussed in light of these findings.

Mindfulness-Based Cognitive Therapy (MBCT) for Health Anxiety (Hypochondriasis): Rationale, Implementation and Case Illustration.

Recent research has shown that mindfulness-based cognitive therapy (MBCT) could be a useful alternative approach to the treatment of health anxiety and deserves further investigation. In this paper, we outline the rationale for using MBCT in the treatment of this condition, namely its hypothesised impact on the underlying mechanisms which maintain health anxiety, such as rumination and avoidance, hypervigilance to body sensations and misinterpretation of such sensations. We also describe some of the adaptations which were made to the MBCT protocol for recurrent depression in this trial and discuss the rationale for these adaptations. We use a case example from the trial to illustrate how MBCT was implemented and outline the experience of one of the participants who took part in an 8-week MBCT course. Finally, we detail some of the more general experiences of participants and discuss the advantages and possible limitations of this approach for this population, as well as considering what might be useful avenues to explore in future research.

Case-Series Evaluating a Transdiagnostic Cognitive-Behavioural Treatment for Co-occurring Anxiety Disorders.

BACKGROUND: Patients with anxiety disorder diagnoses commonly have more than one anxiety diagnosis. While cognitive-behavioural interventions have proven efficacy in treating single anxiety disorder diagnoses, there has been little investigation of their efficacy in treating co-occurring anxiety disorders. AIMS: To evaluate the efficacy of a transdiagnostic cognitive-behavioural intervention for treating co-occurring anxiety disorders. METHOD: An A-B single case study design (N = 6) was used to evaluate the efficacy of a 12 to 13-session modular transdiagnostic cognitive-behavioural intervention for treating co-occurring anxiety disorders across patients with at least two of the following diagnoses: GAD, Social Phobia, Panic Disorder and/or OCD. RESULTS: Five of the six participants completed treatment. At posttreatment assessment the five treatment completers achieved diagnostic and symptomatic change, with three participants being diagnosis free. All participants who completed treatment no longer met criteria for any DSM-IV-TR Axis-I diagnosis at the 3-month follow-up assessment, and demonstrated reliable and clinically-significant improvements in symptoms. Across the participants, statistically significant improvements from pre to postintervention were found on measures of anxiety, depression and general well-being, and all improvements were maintained at 3-month follow-up. CONCLUSIONS: Results suggest that transdiagnostic cognitive behavioural interventions can be of benefit to patients with co-occurring anxiety disorders.

Brief report: Maternal posttraumatic stress symptoms are related to adherence to their child's diabetes treatment regimen.

Although research suggests that posttraumatic stress disorder symptoms in relation to physical health diagnoses may be related to poor adherence to treatment regimens, so far, whether parental posttraumatic stress disorder symptoms have an impact on their child's adherence to insulin-dependent diabetes mellitus treatment has not been investigated. Using self-report questionnaires, the present study found that children of mothers who have posttraumatic stress disorder symptoms in relation to their child's diagnosis of type I diabetes showed poorer adherence to treatment than the children of mothers without posttraumatic stress disorder. However, this was only the case for younger children (aged 0-8 years) where mothers played a more active role in their child's treatment.

Implementation of cognitive therapy for PTSD in routine clinical care: effectiveness and moderators of outcome in a consecutive sample.

OBJECTIVE: Trauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area. METHOD: A consecutive sample of 330 patients with PTSD (age 17-83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects. RESULTS: CT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M=280 days, n=220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience. CONCLUSIONS: The results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.

A systematic review of methods for assessing competence in cognitive-behavioural therapy.

Effective assessment of Cognitive Behaviour Therapy (CBT) competence is crucial to the success of the current drive to expand CBT training and service provision, and to the widespread dissemination of CBT into routine practice. However, a lack of consensus about how CBT competence should be assessed has resulted in the use of numerous different methods, many of which have been widely criticised. This review describes and evaluates the various methods of assessing CBT competence. A systematic literature search identified 64 articles pertaining to a method of assessing competence in the provision of standard CBT interventions to adults experiencing mental health problems. Ten methods for assessing CBT therapist competence were identified from these articles and are presented within Miller's (Miller, G. E. [1990]. The assessment of clinical skills/competence/performance. Academic Medicine, 65, 63-67) framework for assessing clinical skill. The advantages and disadvantages of each method are examined in relation to reliability, validity and feasibility. The limitations of the current evidence base are outlined and priorities for future research are highlighted. Tentative recommendations for assessing therapist competence are made within the context of the limited evidence base and need for feasibility in clinical practice settings.

Randomized trial comparing Internet-based training in cognitive behavioural therapy theory, assessment and formulation to delayed-training control.

OBJECTIVE: There is a need for effective, scalable methods of training clinicians in evidence-based interventions, particularly for populations with significant barriers to accessing traditional methods of training (e.g., developing economies, non-English speaking geographically dispersed populations). Hence this study examined the effectiveness of Internet-based training (IBT) in cognitive behavioural therapy (CBT) theory, assessment and formulation for participants in Russia with limited previous knowledge or training in CBT. METHOD: Participants (N = 63) were randomized to either immediate IBT (approximately three hours over the course of one month) or a delayed training control group. Participants were assessed immediately prior to and following the training/delay on (a) standardized role-play of a CBT assessment and (b) ability to construct CBT formulation of the role-play 'patient'. In addition the feasibility and acceptability of the training was assessed. RESULTS: Responses indicated that translated and subtitled IBT training was perceived by participants to be feasible and acceptable. Following the training those allocated to IBT scored significantly higher on measures of CBT assessment and formulation skills (between group effects sizes of d = 0.77-1.10) than those allocated to the control group. Participants reported IBT to be a feasible and acceptable form of CBT dissemination. An adaptation of the CTS used to rate a standardized role-play assessment demonstrated good inter-rater reliability. CONCLUSIONS: IBT may be an effective and scalable method of CBT dissemination with particular potential for training CBT skills in populations with significant barrier to accessing traditional methods of training.

An investigation of the accuracy of therapists' self-assessment of cognitive-behaviour therapy skills.

BACKGROUND: The impact of cognitive behavioural therapy (CBT) interventions in routine clinical practice depends on those interventions being delivered competently. Since direct observation or independent assessment of therapists' skills are typically limited in routine clinical practice, the assessment of competence, and thus of the need for further training and/or supervision to improve competence, rests mainly on the individual therapist's self-assessment. AIMS: To examine the accuracy of therapists' self-assessment of their CBT competence in relation to supervisors' assessments. METHOD: Self-ratings on the Cognitive Therapy Scale (CTS; Young & Beck, 1980; 1988) from two groups of trainees on established cognitive therapy training courses (n= 64) were compared to supervisors' ratings of the same therapy sessions. RESULTS: There were moderate correlations between self- and supervisor assessments, and the previously reported over-estimation of CBT skills (Brosan, Reynolds, & Moore, 2008) was not replicated in the current sample. Instead, these groups showed under-estimation of their skills compared to supervisors' ratings, with the less-competent trainees' ratings not being significantly different from their supervisors' and the more competent trainees' ratings being significantly lower than those of their supervisors. CONCLUSIONS: Several possible explanations of the results are discussed and recommendations for ensuring the integrity of CBT delivered in routine clinical practice are made.

Cognitive and non-cognitive factors associated with posttraumatic stress symptoms in mothers of children with type 1 diabetes.

BACKGROUND: The experience of having a child diagnosed with type 1 diabetes mellitus (T1DM) can negatively impact on the mother's well-being and trigger posttraumatic stress symptoms. To date, only one study has examined the role of non-cognitive factors in predicting the occurrence of PTSD in parents of children diagnosed with diabetes. However, in the broader PTSD literature is has been shown that both non-cognitive variables and cognitive variables predict PTSD in traumatized populations. AIMS: The current study aimed to investigate the relationship of both non-cognitive (trauma severity, psychiatric history and social support) and cognitive variables (negative cognitive appraisals and dysfunctional cognitive appraisals) with PTSD in mothers of children recently diagnosed with diabetes. METHOD: A single group survey design and self-report questionnaires were used to investigate the relationship between both non-cognitive (trauma severity, psychiatric history and history of trauma, and social support) and cognitive factors (negative cognitive appraisals and dysfunctional strategies) and PTSD symptoms in mothers of children who had been diagnosed with type 1 diabetes in the last 5 years. RESULTS: All cognitive variables were positively associated with PTSD symptoms. In contrast, of the non-cognitive variables, only social support was significantly (negatively) associated with PTSD symptoms. Moreover, regression analysis found that cognitive variables explained variance in PTSD symptoms over and above that contributed by the non-cognitive variables. CONCLUSIONS: This supports the cognitive model of PTSD. The implications of the study with regards to early detection of and therapies for PTSD in this population are discussed.

Cognitive behaviour therapy for low self-esteem: a preliminary randomized controlled trial in a primary care setting.

BACKGROUND AND OBJECTIVES: Low self-esteem (LSE) is associated with psychiatric disorder, and is distressing and debilitating in its own right. Hence, it is frequent target for treatment in cognitive behavioural interventions, yet it has rarely been the primary focus for intervention. This paper reports on a preliminary randomized controlled trial of cognitive behaviour therapy (CBT) for LSE using Fennell's (1997) cognitive conceptualisation and transdiagnostic treatment approach (1997, 1999). METHODS: Twenty-two participants were randomly allocated to either immediate treatment (IT) (n=11) or to a waitlist condition (WL) (n=11). Treatment consisted of 10 sessions of individual CBT accompanied by workbooks. Participants allocated to the WL condition received the CBT intervention once the waitlist period was completed and all participants were followed up 11 weeks after completing CBT. RESULTS: The IT group showed significantly better functioning than the WL group on measures of LSE, overall functioning and depression and had fewer psychiatric diagnoses at the end of treatment. The WL group showed the same pattern of response to CBT as the group who had received CBT immediately. All treatment gains were maintained at follow-up assessment. LIMITATIONS: The sample size is small and consists mainly of women with a high level of educational attainment and the follow-up period was relatively short. CONCLUSIONS: These preliminary findings suggest that a focused, brief CBT intervention can be effective in treating LSE and associated symptoms and diagnoses in a clinically representative group of individuals with a range of different and co-morbid disorders.

A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis).

OBJECTIVE: The efficacy and acceptability of existing psychological interventions for health anxiety (hypochondriasis) are limited. In the current study, the authors aimed to assess the impact of mindfulness-based cognitive therapy (MBCT) on health anxiety by comparing the impact of MBCT in addition to usual services (unrestricted services) with unrestricted services (US) alone. METHOD: The 74 participants were randomized to either MBCT in addition to US (n = 36) or US alone (n = 38). Participants were assessed prior to intervention (MBCT or US), immediately following the intervention, and 1 year postintervention. In addition to independent assessments of diagnostic status, standardized self-report measures and assessor ratings of severity and distress associated with the diagnosis of hypochondriasis were used. RESULTS: In the intention-to-treat (ITT) analysis (N = 74), MBCT participants had significantly lower health anxiety than US participants, both immediately following the intervention (Cohen's d = 0.48) and at 1-year follow-up (d = 0.48). The per-protocol (PP) analysis (n = 68) between groups effect size was d = 0.49 at postintervention and d = 0.62 at 1-year follow-up. Mediational analysis showed that change in mindfulness mediated the group changes in health anxiety symptoms. Significantly fewer participants allocated to MBCT than to US met criteria for the diagnosis of hypochondriasis, both immediately following the intervention period (ITT 50.0% vs. 78.9%; PP 47.1% vs. 78.4%) and at 1-year follow-up (ITT 36.1% vs. 76.3%; PP 28.1% vs. 75.0%). CONCLUSIONS: MBCT may be a useful addition to usual services for patients with health anxiety.

An analysis of matching cognitive-behavior therapy techniques to learning styles.

BACKGROUND AND OBJECTIVES: To optimize the effectiveness of cognitive-behavior therapy (CBT) for each individual patient, it is important to discern whether different intervention techniques may be differentially effective. One factor influencing the differential effectiveness of CBT intervention techniques may be the patient's preferred learning style, and whether this is 'matched' to the intervention. METHOD: The current study uses a retrospective analysis to examine whether the impact of two common CBT interventions (thought records and behavioral experiments) is greater when the intervention is either matched or mismatched to the individual's learning style. RESULTS: Results from this study give some indication that greater belief change is achieved when the intervention technique is matched to participants' learning style, than when intervention techniques are mismatched to learning style. LIMITATIONS: Conclusions are limited by the retrospective nature of the analysis and the limited dose of the intervention in non-clinical participants. CONCLUSIONS: Results suggest that further investigation of the impact of matching the patient's learning style to CBT intervention techniques is warranted, using clinical samples with higher dose interventions.

Preliminary evaluation of an online training package in cognitive behaviour therapy: satisfaction ratings and impact on knowledge and confidence.

BACKGROUND: Online CBT training is in its infancy. The initial studies have varied program characteristics and trainee groups, but results appear promising. At this stage, there is a need to evaluate programs with different characteristics to determine which are useful, and which are not. METHOD: This paper reports a preliminary evaluation of an online CBT training package, OCTC Online, which is distinguished from other online programs by its particularly strong focus on video presentations by trainers, accompanying PowerPoint slides, and video demonstrations of key clinical techniques. Participants (N = 94) completed online rating scales and questionnaires assessing (a) their satisfaction with the training; (b) their self-rated knowledge and confidence about the topics discussed (pre- and post-training); and (c) a multiple choice questionnaire (MCQ) objective test of knowledge (also pre- and post-training). RESULTS: Results showed that on average students were highly satisfied with the online training modules, their self-rated confidence increased significantly, and so did their scores on the MCQ. CONCLUSIONS: The study has significant limitations but nevertheless contributes to the growing body of evidence that online training may have a useful part to play in enhancing therapists' knowledge of CBT theory and techniques, and their confidence in using the techniques.

Cyberchondriasis: fact or fiction? A preliminary examination of the relationship between health anxiety and searching for health information on the Internet.

This study examined the relationship between health anxiety and searching for health information online, a phenomenon dubbed 'cyberchondria'. The majority of those with 'high' (n=46) and 'low' (n=36) levels of health anxiety reported seeking health information online. However, those with higher levels of health anxiety sought online health information more frequently, spent longer searching, and found searching more distressing and anxiety provoking. Furthermore, more responses in the high than low health anxiety group related to searching for information on diagnosed and undiagnosed medical conditions, descriptions of others' experiences of illnesses and using message boards/support groups, although the largest proportion of responses in both groups was accounted for by seeking information on symptoms. Linear regression (n=167) revealed significant relationships between health anxiety and the frequency, duration and distress and anxiety associated with searching for health information online. This preliminary data suggests that searching for health information online may exacerbate health anxiety.

Mindfulness-based cognitive therapy for severe health anxiety (hypochondriasis): an interpretative phenomenological analysis of patients' experiences.

OBJECTIVE. Severe health anxiety (hypochondriasis) is a common and disabling condition for which existing psychological treatments have limited effects (Thomson & Page, 2007). Hence, it is a priority to examine both the efficacy and acceptability of new psychological treatments for health anxiety. The aim of this study was to explore the experiences of participants with severe health anxiety who received Mindfulness-based Cognitive Therapy (MBCT) as part of a randomized controlled trial. DESIGN. Semi-structured interviews were carried out 3 months after participants completed MBCT in order to explore their experiences of the course and subsequent self-managed practice. METHODS. Interpretative Phenomenological Analysis (Smith, 1996) was used to analyze interview transcripts from nine participants who had received MBCT. RESULTS. Two main themes emerged from the analysis: (1) My awareness of barriers to experiencing change through MBCT, and (2) Cultivation of a new approach to health anxiety and my life in general. CONCLUSIONS. The majority of participants considered MBCT to be an acceptable and beneficial treatment for health anxiety. Participants reported beneficial impacts of MBCT both on their health anxiety and on their broader functioning. Importantly, the focusing of attention upon bodily sensations required in MBCT practice did not exacerbate participants' health anxiety.