Improvements in behavior following active interventions diminish over time across a broad spectrum of behaviors. Motivational interviewing (MI) has been found to increase intrinsic motivation for initial behavior change, but there has been little discussion on how to integrate MI and the cognitive-behavioral treatments (CBTs) commonly used to maintain change. A prominent CBT approach to relapse prevention that has been tested in multiple behavioral domains includes the following maintenance strategies: managing the goal violation effect, flexible goal setting, identifying triggers and developing coping skills, and increasing self-efficacy and social support. Using a model of integration where MI is the foundation for CBT delivery, the integration of specific relational and technical components of MI and CBT strategies for maintenance of change are described. A universal maintenance intervention that uses MI as an integrative framework to deliver CBT may address maintenance of behavior change across multiple behavioral domains. Further research is necessary to confirm whether delivering MI with fidelity adds to the effectiveness of CBT maintenance interventions.

Although comorbid substance use is a common problem in bipolar disorder, there has been little research into options for psychological therapy. Studies to date have concentrated on purely cognitive-behavioural approaches, which are not equipped to deal with the ambivalence to change exhibited by many towards therapy designed to change substance use. This paper provides the first report of an integrated psychological treatment approach for bipolar disorder with comorbid substance use. The intervention reported combines motivational interviewing and cognitive-behavioural therapy to address ambivalence and equips individuals with strategies to address substance use. Across five individual case studies, preliminary evidence is reported to support the acceptability and the feasibility of this approach. Despite most participants not highlighting their substance use as a primary therapy target, all but one exhibited reduced use of drugs or alcohol at the end of therapy, sustained at 6 months' follow-up. There was some evidence for improvements in mood symptoms and impulsiveness, but this was less clear-cut. The impact of social and relationship issues on therapy process and outcome is discussed. The implications of the current findings for future intervention research in this area are considered.

The MI-CTS is useful for assessing adherence to integrated MI-CBT for psychosis and substance misuse and could aid training and implementation of the approach.

Aims and MethodThe need for training to prepare mental health professionals to assess and manage risks is now well established. This paper reports on the development, delivery and evaluation of interprofessional clinical risk training in Salford and Manchester since 1998. A training-needs analysis was carried out, followed by post-training evaluation and an impact-monitoring questionnaire.ResultsThe training was very well received by participants, with over 90% of them meeting the objectives and 100% of respondents reporting that the training had a positive impact on their clinical practice more than 12 months afterwards.Clinical ImplicationsThe evaluation of the training demonstrates that a properly planned and delivered 2-day clinical risk assessment course can have a positive impact on the practice of clinicians in mental health services. However, this should be seen only as an introductory course, as more advanced risk training is required. This is currently being delivered and planned.

Aims and MethodThe need for training to prepare mental health professionals to assess and manage risks is now well established. This paper reports on the development, delivery and evaluation of interprofessional clinical risk training in Salford and Manchester since 1998. A training-needs analysis was carried out, followed by post-training evaluation and an impact-monitoring questionnaire.ResultsThe training was very well received by participants, with over 90% of them meeting the objectives and 100% of respondents reporting that the training had a positive impact on their clinical practice more than 12 months afterwards.Clinical ImplicationsThe evaluation of the training demonstrates that a properly planned and delivered 2-day clinical risk assessment course can have a positive impact on the practice of clinicians in mental health services. However, this should be seen only as an introductory course, as more advanced risk training is required. This is currently being delivered and planned.