Cognitive behavioural therapy (CBT) is an effective psychological treatment for anxiety-related disorders (anxiety disorders, post-traumatic stress disorder, and obsessivecompulsive disorder). However, relapse of anxiety symptoms is common following completion of treatment. This study aimed to identify predictors of relapse of anxiety after CBT for adult (18+) patients to enable the identification of 'at-risk' patients who could potentially benefit from relapse prevention interventions. A systematic review and meta-analysis was conducted, including studies found in PsycINFO, PubMed, Scopus, and Web of Science, and through hand-searches of references lists and reverse citations. Nine studies met eligibility criteria (N=532 patients). On average, 23.8% of patients experienced relapse following completion of CBT. A total of 21 predictors were identified and grouped into seven categories: residual symptoms; personality disorders; medication; clinical features; stressful life-events; degree of improvement; and demographics. A meta-analysis of residual symptoms as a predictor of relapse yielded a moderate but non-significant pooled effect size (r=0.35; 95% CI -0.21, 0.74, p = .08). Further research with adequately powered samples and standardised operationalisations of relapse are required to identify robust predictors.

We examined the relation between maternal responsiveness and children's acquisition of mental and non-mental state vocabulary in 59 pairs of mothers and children aged 10 to 26 months as they engaged in a free-play episode. Children wore a head camera and responsiveness was defined as maternal talk that commented on the child's actions (e.g., when the child reached for or manipulated an object visible in the head camera). As hypothesized, maternal responsiveness correlated with both mental and non-mental state vocabulary acquisition in younger children (approximately 18 months and younger) but not older children. We posit a diminishing role for maternal responsiveness in language acquisition as children grow older.

Objective: Many patients relapse within one year of completing effective cognitive behavioural therapy (CBT) for depression and anxiety. Residual symptoms at treatment completion have been demonstrated to predict relapse, and so this study used network analyses to improve specificity regarding which residual anxiety and depression symptoms predict relapse. Method: A cohort study identified relapse cases following low-and high-intensity CBT in a stepped care psychological therapy service. The sample included N=867 'recovered' treatment completers that attended a six-month follow-up review. At follow-up, N=93 patients had relapsed and N=774 remained in-remission. Networks of final treatment session depression (PHQ-9) and anxiety (GAD-7) symptoms were estimated for both subgroups. Results: Qualitatively similar symptom networks were found. Difficulty concentrating was a highly central symptom in the relapse network, whilst of only average centrality in the remission network. In contrast, trouble relaxing was highly central in the remission network, whilst of only average centrality in the relapse network. Discussion: Identification of central residual symptoms holds promise in improving the specificity of prognostic models and the design of evidence-based relapse prevention strategies. The small sample of relapse cases limits this study's ability to draw firm conclusions.

Background People with severe mental ill health (SMI) experience some of the largest health inequalities of any sector within society. For these inequalities to be reduced, an understanding of the behavioural determinants of health in this population is needed. Aims Utilising data from the Closing the Gap Health Study, we aimed to assess the extent to which people with SMI report health-risk factors and behaviours, their interest in modifying them, and the factors associated with being motivated to modify these behaviours. Method Adult (≥18 years old) participants were recruited via primary and secondary care in the English National Health Service. To be eligible, participants needed to have a documented diagnosis of schizophrenia, psychotic disorders or bipolar disorder. Data were collected by survey on demographics, general physical health, diet, physical activity, alcohol, smoking and body mass index. Results Between April 2016 and March 2020, n = 9914 participants were recruited. Among people with SMI, high rates of obesity (37.5%), infrequent physical activity (62.0%), not meeting current guidelines (≥5) for the consumption of fruit and vegetables (85.0%) and smoking (42.2%) were observed. However, most participants were motivated to reduce health-risk behaviours. Perceiving the importance of health-promoting behaviours, being of poorer general health and being female were significantly associated with being motivated to modify health-risk behaviours. Conclusions Despite experiencing poor physical and mental health outcomes compared with the general population, and contrary to popular misconceptions, people with SMI perceive health as important and are motivated to make behavioural changes to improve health.

Background: Some patients return for further psychological treatment in routine services, although it is unclear how common this is, as scarce research is available on this topic. Aims: To estimate the treatment return rate and describe the clinical characteristics of patients who return for anxiety and depression treatment. Method: A large dataset (N=21,029) of routinely collected clinical data (2010–2015) from an English psychological therapy service was analysed using descriptive statistics. Results: The return rate for at least one additional treatment episode within 1–5 years was 13.7%. Furthermore, 14.5% of the total sessions provided by the service were delivered to treatment-returning patients. Of those who returned, 58.0% continued to show clinically significant depression and/or anxiety symptoms at the end of their first treatment, while 32.0% had experienced a demonstrable relapse before their second treatment. Conclusions: This study estimates that approximately one in seven patients return to the same service for additional psychological treatment within 1–5 years. Multiple factors may influence the need for additional treatment, and this may have a major impact on service activity. Future research needs to further explore and better determine the characteristics of treatment returners, prioritise enhancement of first treatment recovery, and evaluate relapse prevention interventions.