Aims and method To establish the competency of psychiatric trainees in delivering cognitive–behavioural therapy (CBT) to selected cases, following introductory lectures and supervision. Supervisor reports of trainees rotating through a national psychiatric hospital over 8.5 years were reviewed along with revised Cognitive Therapy Scale (CTS-R) ratings where available. Independent t-test was used to compare variables.Results Structured supervision reports were available for 52 of 55 (95%) trainees. The mean result (4.6, s.d. = 0.9) was at or above the accepted level for competency (≥3) for participating trainees. Available CTS-R ratings (n = 22) supported the supervisor report findings for those particular trainees.Clinical implications This study indicates that trainees under supervision can provide meaningful clinical interventions when delivering CBT to selected cases. The costs of supervision need to be judged against these clinical gains.

Exposure and response prevention (ERP) is the behavioural treatment of choice for obsessive-compulsive disorder (OCD).1 Many early studies showed 70-75% improvement after 15 sessions of ERP, 2,3 but later studies showed positive gains from cognitive approaches aimed at reducing obsessions and rituals. Several cognitive models have been proposed for OCD, including those of Salkovskis 4 and Rachman. 5 Rachman suggests that obsessions are caused by catastrophic misinterpretation of the significance of one's thoughts as originating in normal intrusive thoughts which are interpreted in relation to responsibility beliefs, controllability of thoughts and beliefs concerning danger and threat. Danger ideation reduction therapy, for individuals with OCD with washing/contamination concerns, has been shown to be as useful as ERP. [6][7][8] Despite increasing interest in the role of cognitive therapy in the treatment of OCD, there is limited evidence to suggest that cognitive therapy is superior to ERP. In a study of three groups, one receiving cognitive therapy alone, one receiving ERP alone and one receiving ERP with cognitive therapy, there were no reported differences between the groups.9 Another study showed no difference between rational emotive therapy (analysing irrational thoughts) and exposure in vivo. 10Patients with OCD respond well to individual therapy combining behavioural and cognitive approaches (cognitivebehavioural therapy, CBT) when delivered by a trained therapist.11 Unfortunately, the supply of trained CBT therapists is limited, leading to long waiting lists for this essential psychotherapy. Despite this, few studies have examined the effectiveness of group therapy for OCD. Krone et al 12 used psychoeducation about cognitive therapy and ERP approaches with 36 patients in weekly groups for 7 weeks. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores changed significantly from moderately severe before treatment to below clinical levels at 3-month follow-up. A further study compared three groups: group one received ERP, group two received individual ERP and group three received individual sessions of progressive muscle relaxation. This study demonstrated that, after 2 h once-weekly sessions, both individual and group ERP showed significant post-treatment improvement in OCD symptoms, depression and anxiety scores. 13 Bouvard et al 14 reported that 19 patients treated with six sessions of cognitive therapy followed by six sessions of ERP had a significant improvement following the cognitive therapy, but the addition of the ERP did not improve the patients further. The study was uncontrolled and non-randomised, but the clinical impression was that cognitive therapy helped to maintain the results in the long term. MethodAs a result of the limited data available on group CBT for patients with OCD, we undertook this naturalistic study in Clinical implications Cognitive-behavioural therapy for OCD delivered in a group setting is a clinically effective and acceptable treatment for patients. The use of groupbased...

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