This review summarizes the current meta-analysis literature on treatment outcomes of CBT for a wide range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically rigorous meta-analyses. Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT. D 2005 Elsevier Ltd. All rights reserved.Cognitive-behavioral therapy is one of the most extensively researched forms of psychotherapy. Over 120 controlled clinical trials were added to the literature in the eight years between 1986(Hollon & Beck, 1994 and this proliferation has continued (Dobson, 2001). There are now over 325 published outcome studies on cognitive-behavioral interventions. This growth is due in part to the ongoing adaptation of CBT for an increasingly wider range of disorders and problems (Beck, 1997;Salkovskis, 1996). Yet, many questions remain regarding the overall effectiveness of CBT, its differential effectiveness by disorder, the nature of the control groups by which its effectiveness has been established, and the extent to which its effects persist following the cessation of treatment. In this paper we review evidence from meta-analyses that address these questions. Our approach is unique in that we systematically summarize findings across high-quality meta-analyses for 16 different disorders. We focus on direct comparisons of CBT to alternative treatments wherever possible.A review of meta-analyses on CBT outcomes is particularly relevant to the ongoing debate about the comparative efficacy of different treatments (Rounsaville & Carroll, 2002). For instance, a recent review of meta-analyses and 0272-7358/$ -see front matter D

The purpose of this project was to develop a bidimensional measure of mindfulness to assess its two key components: present-moment awareness and acceptance. The development and psychometric validation of the Philadelphia Mindfulness Scale is described, and data are reported from expert raters, two nonclinical samples (n = 204 and 559), and three clinical samples including mixed psychiatric outpatients (n = 52), eating disorder inpatients (n = 30), and student counseling center outpatients (n = 78). Exploratory and confirmatory factor analyses support a two-factor solution, corresponding to the two constituent components of the construct. Good internal consistency was demonstrated, and relationships withother constructs were largely as expected. As predicted, significant differences were found between the nonclinical and clinical samples in levels of awareness and acceptance. The awareness and acceptance subscales were not correlated, suggesting that these two constructs can be examined independently. Potential theoretical and applied uses of the measure are discussed.

Acceptance and commitment therapy (ACT) has a small but growing database of support. One hundred and one heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned to traditional cognitive therapy (CT) or to ACT. To maximize external validity, the authors utilized very minimal exclusion criteria. Participants receiving CT and ACT evidenced large, equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction, and clinician-rated functioning. Whereas improvements were equivalent across the two groups, the mechanisms of action appeared to differ. Changes in "observing" and "describing" one's experiences appeared to mediate outcomes for the CT group relative to the ACT group, whereas "experiential avoidance," "acting with awareness," and "acceptance" mediated outcomes for the ACT group. Overall, the results suggest that ACT is a viable and disseminable treatment, the effectiveness of which appears equivalent to that of CT, even as its mechanisms appear to be distinct.

To date, few studies have been published on the dose‐response relationship, but there is general consensus that between 13 and 18 sessions of therapy are required for 50% of patients to improve. Reviewing the clinical trials literature reveals that in carefully controlled and implemented treatments, between 57.6% and 67.2% of patients improve within an average of 12.7 sessions. Using naturalistic data, however, revealed that the average number of sessions received in a national database of over 6,000 patients was less than five. The rate of improvement in this sample was only about 20%. These results suggest that patients, on average, do not get adequate exposure to psychotherapy, nor do they recover from illness at rates observed in clinical trials research.

The increased popularity and functionality of mobile devices has a number of implications for the delivery of mental health services. Effective use of mobile applications has the potential to (a) increase access to evidence-based care; (b) better inform consumers of care and more actively engage them in treatment; (c) increase the use of evidence-based practices; and (d) enhance care after formal treatment has concluded. The current paper presents an overview of the many potential uses of mobile applications as a means to facilitate ongoing care at various stages of treatment. Examples of current mobile applications in behavioural treatment and research are described, and the implications of such uses are discussed. Finally, we provide recommendations for methods to include mobile applications into current treatment and outline future directions for evaluation.

Guided by the emotional security hypothesis, this study reports on the development of a new self-report measure that assesses children's strategies for preserving emotional security in the context of interparental conflict. Participants were 924 sixth, seventh, and eighth graders and a subset of their mothers, fathers, and teachers. Exploratory and confirmatory factor analyses of the Security in the Interparental Subsystem (SIS) Scale supported a seven-factor solution, corresponding well to the three component processes (i.e., emotional reactivity, regulation of exposure to parent affect, and internal representations) outlined in the emotional security hypothesis. The SIS subscales demonstrated satisfactory internal consistency and test-retest reliability. Support for the validity of the SIS Scale is evidenced by its significant links with parent reports of children's overt reactivity to conflict, children's responses to interparental conflict simulations 6 months later, and children's psychological maladjustment and experiential histories with interparental conflict across multiple informants (i.e., child, mother, father, and teacher). Results are discussed in the context of developing recommendations for use of the SIS and advancing the emotional security hypothesis.

Results indicate that multiple attempters display more severe psychopathology, suicidality, and interpersonal difficulties and are more likely to have histories of deleterious background characteristics than single attempters. Moreover, these differences cannot be explained by the diagnosis of borderline personality disorder. Results suggest that the identification of attempt status is a simple, yet powerful, means of gauging levels of risk and psychopathology.

Over the 20 years since the criteria for empirically supported treatments (ESTs) were published, standards for synthesizing evidence have evolved and more systematic approaches to reviewing the findings from intervention trials have emerged. Currently, the APA is planning the development of treatment guidelines, a process that will likely take many years. As an intermediate step, we recommend a revised set of criteria for ESTs that will utilize existing systematic reviews of all of the available literature, and recommendations that address the methodological quality, outcomes, populations, and treatment settings included in the literature.