Acceptance and Commitment Therapy (ACT) emphasizes the relationship a person has with their thoughts and beliefs as potentially more relevant than belief content in predicting the emotional and behavioral consequences of cognition. In ACT, 'defusion' interventions aim to 'unhook' thoughts from actions and to create psychological distance between a person and their thoughts, beliefs, memories and self-stories. A number of similar concepts have been described in the psychology literature (e.g. decentering, metacognition, mentalization and mindfulness) suggesting converging evidence that how we relate to mental events may be of critical importance. Whilst there are some good measures of these related processes, none of them provides an adequate operationalization of cognitive fusion. Despite the centrality of cognitive fusion in the ACT model, there is as yet no agreed measure of cognitive fusion. This paper presents the construction and development of a brief, self-report measure of cognitive fusion: The Cognitive Fusion Questionnaire (CFQ). The results of a series of studies involving over 1800 people across diverse samples show good preliminary evidence of the CFQ's factor structure, reliability, temporal stability, validity, discriminant validity, and sensitivity to treatment effects. The potential uses of the CFQ in research and clinical practice are outlined.

An overly optimistic, professionally imposed view of recovery might homogenise or even blame individuals rather than empower them. Further understanding is needed of different experiences of recovery, and of people's struggles to recover.

BackgroundAccess to Cognitive behavioural therapy (CBT) for depression is limited. One solution is CBT self-help books. Trial Objectives: To assess the impact of a guided self-help CBT book (GSH-CBT) on mood, compared to treatment as usual (TAU).Hypotheses:GSH-CBT will have improved mood and knowledge of the causes and treatment of depression compared to the control receiving TAUGuided self-help will be acceptable to patients and staff. Methods and Findings Participants: Adults attending seven general practices in Glasgow, UK with a BDI-II score of ≥14. 141 randomised to GSH-CBT and 140 to TAU. Interventions: RCT comparing ‘Overcoming Depression: A Five Areas Approach’ book plus 3–4 short face to face support appointments totalling up to 2 hours of guided support, compared with general practitioner TAU. Primary outcome: The BDI (II) score at 4 months. Numbers analysed: 281 at baseline, 203 at 4 months (primary outcome), 117 at 12 months. Outcome: Mean BDI-II scores were lower in the GSH-CBT group at 4 months by 5.3 points (2.6 to 7.9, p<0.001). At 4 and 12 months there were also significantly higher proportions of participants achieving a 50% reduction in BDI-II in the GSH-CBT arm. The mean support was 2 sessions with 42.7 minutes for session 1, 41.4 minutes for session 2 and 40.2 minutes of support for session 3. Adverse effects/Harms: Significantly less deterioration in mood in GSH-CBT (2.0% compared to 9.8% in the TAU group for BDI—II category change).Limitations Weaknesses: Our follow-up rate of 72.2% at 4 months is better than predicted but is poorer at 12 months (41.6%). In the GSH-CBT arm, around 50% of people attended 2 or fewer sessions. 22% failed to take up treatment.ConclusionsGSH-CBT is substantially more effective than TAU.Trial RegistrationControlled-Trials.com ISRCTN13475030

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For innovative up-to-date research in an area to be developed, it is important to systematically, and critically evaluate the previous research. Sexual violence against children is one of the most serious crimes, with detrimental psychological and physical consequences on the victims. Contemporary theories of the development and maintenance of sexual offending against children incorporate intimacy deficits and social skills deficits. However, there is a dearth of research addressing the clinical needs of males who commit sexual offences against children. This systematic review critically evaluates previous research on the association between social anxiety and sexual offending against children. To identify studies relevant databases were searched and selected journals hand searched. Studies were evaluated for eligibility, data extracted and study quality assessed, with a second rater to establish inter-rater reliability. The results indicate eight of the eighteen studies reviewed reported an inconclusive statistical association with child sex offenders and social anxiety. Of the remaining ten studies, one study had a strong statistical association, four studies had a moderate statistical association and five studies were weak statistical association. Overall, the findings indicate methodological inconsistencies and lack of definitional clarity of subgroups of sex offenders, therefore comparison between studies is challenging.Further research in this area with definitional clarity of subgroups is required to inform evidence-based practice for this offender group.