Results to date are promising and this relatively young field is now close to a point where these kinds of cognitive interventions can be recommended to educators. Further research with refined methodology and more diverse samples is required before firm recommendations may be made for medical education and policy; however, these results suggest that such interventions hold promise, with much current enthusiasm for new research.

The need to provide effective mental health treatments for adolescents has been described as a 'global public health challenge ' [27]. In this paper we discuss the exploratory evaluations of the first adolescent intervention to fully integrate a computer game implementing Cognitive Behavioural Therapy. Three distinct studies are presented: a detailed evaluation in which therapists independent of the design team used the game with 6 adolescents experiencing clinical anxiety disorders; a study in which a member of the design team used the game with 15 adolescents; and finally a study assessing the acceptability of the game and intervention with 216 practicing therapists. Findings are presented within the context of a framework for the design and evaluation of complex health interventions. The paper provides an in-depth insight into the use of therapeutic games to support adolescent interventions and provides stronger evidence than previously available for both their effectiveness and acceptability to stakeholders.

Self-compassion has emerged as an important construct in the mental health literature. Although conceptual links between self-compassion and trauma are apparent, a review has not been completed to examine whether this association is supported by empirical research findings. To systematically summarize knowledge on the association between trauma and/or posttraumatic stress disorder (PTSD) and self-compassion. Searches were conducted in PsycINFO, PubMed, Ovid Medline, Web of Science, Embase, and PILOTS databases, and papers reporting a direct analysis on the relationship between these constructs were identified. The search yielded 35 studies meeting inclusion criteria. Despite considerable heterogeneity in study design, sample, measurement, and trauma type, there was consistent evidence to suggest that increased self-compassion is associated with less PTSD symptomatology and some evidence to suggest that reduced fear of self-compassion is associated with less PTSD symptomatology. There was tentative evidence to suggest that interventions based, in part or whole, on a self-compassion model potentially reduce PTSD symptoms. Although findings are positive for the association between increased selfcompassion and reduced PTSD symptoms, the precise mechanism of these protective effects is unknown. Prospective and longitudinal studies would be beneficial in clarifying this. The review also highlighted the variability in what is and should be referred to as trauma exposure, indicating the need for further research to clarify the concept. K E Y W O R D Sself-compassion, fear of self-compassion, trauma, posttraumatic stress disorder, review

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Acknowledgements: This project was partially funded by grants from the Department of Justice, Equality and Law Reform and the Eastern Regional Health Authority. Thanks to all colleagues in the prison services, the community employment scheme, the wholesale company and the TCD research panel for their co-operation and assistance. Results. A secure adult attachment style was four times less common in the child sex offender group than in any of the other three groups. 93% of sex offenders had an insecure adult attachment style and the majority (59%) had a fearful-insecure attachment style. Compared with community controls, the child sex offender group reported significantly lower levels of maternal and paternal care and significantly higher levels of maternal and paternal overprotection during their childhood. Compared with all three comparison groups, the child sexual offenders reported significantly more emotional loneliness and a more external locus of control.With respect to anger management, the child sexual offenders' profile more closely approximated those of non-violent offenders and community controls than that of violent offenders. Conclusions.Insecure attachment was a vulnerability factor uniquely associated with child sex offending in this study. Compared with violent and non-violent offenders and community controls, the child sexual offenders evaluated in this study were also characterized by poorer psychosocial adjustment and an anger management profile closer to the normal range than that of violent offenders.Attachment Styles 4

Despite the evidence base for computer-assisted cognitive-behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.To evaluate the utility of a CBT computer game for adults who have an intellectual disability.A 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.A significant group × time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.As the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

Due to their high associated dropout rates, self-help cCBT programmes such as MoodGYM should not be provided as front-line treatments. However, as it is likely to be agreeable and beneficial to some service users, perhaps self-help cCBT should be provided as an additional treatment option.

The confounding influence of several variables, and presence of publication bias, means that the results of this meta-analysis should be interpreted with caution. Tentative support is provided for MoodGYM's effectiveness for symptoms of depression and general psychological distress. The programme's medium effect on anxiety symptoms demonstrates its utility for people with this difficulty. MoodGYM benefits from its free accessibility over the Internet, but adherence rates can be problematic and at the extreme can fall below 10%. We conclude that MoodGYM is best placed as a population-level intervention that is likely to benefit a sizeable minority of its users.