David M Clark

David M Clark
University of Oxford | OX · Department of Experimental Psychology

DPhil

About

298
Publications
233,450
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43,531
Citations
Additional affiliations
October 2000 - September 2011
King's College London
October 1979 - September 2000
University of Oxford

Publications

Publications (298)
Article
Full-text available
Negative cognitions play a central role in adolescent social anxiety, and yet there is a lack of empirically validated measures assessing these in detail. This study describes the adaptation of the Child & Adolescent Social Cognitions Questionnaire (CASCQ) from the adult version of the scale and its preliminary validation in a general adolescent sc...
Article
Background: Cognitive therapy for SAD (CT-SAD) is a first-line recommended treatment for adult social anxiety disorder (SAD) and shows considerable promise for youth. However, the high prevalence of adolescent SAD and limited number of therapists presents an implementation challenge. Delivery of CT-SAD via the Internet may offer part of the soluti...
Article
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Background Cognitive therapy for social anxiety disorder (CT-SAD) is recommended by NICE (2013) as a first-line intervention. Take up in routine services is limited by the need for up to 14 ninety-min face-to-face sessions, some of which are out of the office. An internet-based version of the treatment (iCT-SAD) with remote therapist support may ac...
Article
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Background Understanding the role of self-imagery in the development of social anxiety in adolescence holds promise for improving intervention. Cross-sectional studies indicate that imagery characteristics are associated with social anxiety symptoms, however, prospective studies are lacking. The current study examined concurrent and prospective ass...
Article
Background: Automated virtual reality therapies are being developed to increase access to psychological interventions. We assessed the experience with one such therapy of patients diagnosed with psychosis, including satisfaction, side effects, and positive experiences of access to the technology. We tested whether side effects affected therapy. M...
Article
Background Automated delivery of psychological therapy using immersive technologies such as virtual reality (VR) might greatly increase the availability of effective help for patients. We aimed to evaluate the efficacy of an automated VR cognitive therapy (gameChange) to treat avoidance and distress in patients with psychosis, and to analyse how an...
Article
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Background Research is needed to determine the extent to which internet-delivered psychological therapies are effective when delivered in countries and cultures outside of where they were developed. Objective This waitlist-controlled study evaluated the efficacy of a UK-developed, therapist-guided internet Cognitive Therapy programme for Social An...
Article
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Background Many patients with mental health disorders become increasingly isolated at home due to anxiety about going outside. A cognitive perspective on this difficulty is that threat cognitions lead to the safety-seeking behavioural response of agoraphobic avoidance. Aims We sought to develop a brief questionnaire, suitable for research and clin...
Article
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Therapist cognitions about trauma-focused psychological therapies can affect our implementation of evidence-based therapies for post-traumatic stress disorder (PTSD), potentially reducing their effectiveness. Based on observations gleaned from teaching and supervising one of these treatments, cognitive therapy for PTSD (CT-PTSD), ten common ‘miscon...
Article
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Face masks are now seen as a key tool in the world’s recovery from the COVID-19 pandemic. However, during the early stages of the outbreak, face mask use in the United Kingdom (UK) was significantly lower than that of countries equally impacted by the virus. We were interested to explore whether social cognitions played a role in levels of mask wea...
Article
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Studies that look to disseminate psychological therapies in different countries often discuss whether and how much cultural adaptation may be required. However, most do not provide sufficient descriptions of how language translation and cultural adaptations were performed, and rarely give examples of specific changes. This makes it hard to understa...
Article
Background Safety behaviours have been shown to be a key maintaining factor in Social Anxiety Disorder (SAD). In adults, a two-factor structure of safety behaviours reflecting ‘avoidance’ and ‘impression-management’ types has been identified. This has not yet been investigated in adolescents. Aims We set out to investigate the factor structure of...
Article
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The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) is a valid and reliable clinician-administered measure of social anxiety symptoms in young people. It has been adapted for self-report completion, and although the psychometric properties of this version of the scale have been examined in Spanish, Hebrew, and French language...
Article
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Background. Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. Avoidance can be due to a variety of fears, including concerns about negative social evaluation, panicking, and harm from others. The result is inactivity and isolation. Behavioural avoidance tasks (BATs) provide an objective assessment of...
Article
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Social anxiety is associated with reduced educational achievement. Given that concentration is a predictor of educational achievement, and social anxiety symptoms are associated with reduced concentration in class, this prospective study examined the possibility that social anxiety may impair educational achievement through reduced classroom concen...
Article
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Background: Working alliance has been shown to predict outcome of psychological treatments in multiple studies. Conversely, changes in outcome scores have also been found to predict working alliance ratings. Objective: To assess the temporal relationships between working alliance and outcome in 230 patients receiving trauma-focused cognitive behavi...
Article
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Background: Cognitive therapy, based on the Clark and Wells (1995) model, is a first-line treatment for adults with social anxiety disorder (SAD), and findings from research settings suggest it has promise for use with adolescents (Cognitive Therapy for Social Anxiety Disorder in Adolescents; CT-SAD-A). However, for the treatment to be suitable fo...
Article
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Background: Social anxiety disorder (SAD) is common. It usually starts in adolescence, and without treatment can disrupt key developmental milestones. Existing generic treatments are less effective for young people with SAD than with other anxiety disorders, but an adaptation of an effective adult therapy (CT-SAD-A) has shown promising results for...
Article
Background Social anxiety disorder (SAD) is common, typically starts in adolescence and has a low natural recovery rate. Existing psychological treatments for adolescent SAD are only moderately effective. It is possible that recovery rates for adolescents could be substantially improved by adapting a psychological therapy that is highly effective a...
Article
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Background Self-focused attention and safety behaviours are both associated with adolescent social anxiety. In adults, experimental studies have indicated that the processes are causally implicated in social anxiety, but this hypothesis has not yet been tested in a youth sample. Methods This experiment explored this possibility by asking high and...
Article
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Background: Numerous studies have shown that trauma-focused psychological treatments for PTSD are effective (Lewis, Roberts, Andrew, Starling, & Bisson, 2020 Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European...
Article
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Background: Cognitive therapies are developed on the principle that specific cognitive appraisals are key determinants in the development and maintenance of mental health disorders. It is likely that particular appraisals of the coronavirus pandemic will have explanatory power for subsequent mental health outcomes in the general public. To enable...
Article
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Background Social anxiety disorder (SoAD) in youth is often treated with a generic form of cognitive behavioural therapy (CBT). Some studies have suggested that primary SoAD is associated with lower recovery rates following generic CBT compared with other anxiety disorders. Aims This systematic review and meta-analysis investigated recovery rates...
Article
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Background Identifying psychological processes that maintain social anxiety holds promise for improving treatment outcomes for young people. Experimental and prospective studies in adults suggest negative social cognitions, safety behaviours, self-focused attention, and pre- and post-event processing are all implicated in the maintenance of social...
Article
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Background During adolescence, peer relationships take precedence and there is a normative increase in social anxiety. Although prospective studies have suggested peer functioning and social anxiety can influence each other, their findings have not been examined systematically. We performed a systematic review and meta-analysis of prospective studi...
Article
Background: Evidence-based treatment for panic disorder consists of disorder-specific cognitive behavioural therapy (CBT) protocols. However, most measures of CBT competence are generic and there is a clear need for disorder-specific assessment measures. Aims: To fill this gap, we evaluated the psychometric properties of the Cognitive Therapy Co...
Article
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Background In face-to-face (offline) social situations a tendency, or bias, to negatively interpret ambiguous situations is consistently related to social anxiety. Although social interactions increasingly occur over the Internet (online), our understanding of cognitive processes in online social situations and how they relate to social anxiety, so...
Article
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Remote delivery of evidence-based psychological therapies via video conference has become particularly relevant following the COVID-19 pandemic, and is likely to be an on-going method of treatment delivery post-COVID. Remotely delivered therapy could be of particular benefit for people with social anxiety disorder (SAD), who tend to avoid or delay...
Article
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Delivering trauma-focused cognitive behavioural therapy to patients with PTSD during the COVID-19 pandemic poses challenges. The therapist cannot meet with the patient in person to guide them through trauma-focused work and other treatment components, and patients are restricted in carrying out treatment-related activities and behavioural experimen...
Article
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Background Most studies examining processes of change in psychological therapy for social anxiety disorder (SAD) have analysed data from randomised controlled trials in research settings. Method To assess whether these findings are representative of routine clinical practice, we analysed audit data from two samples of patients who received Cogniti...
Article
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The automated delivery of psychological treatment using virtual reality (VR) has the potential to revolutionise patient access to evidence-based care. VR creates immersive, interactive computer simulations, which elicit responses similar to the real world. VR simulations provide an ideal opportunity for the experimentation and experiential learning...
Article
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Around a quarter of patients treated in intensive care units (ICUs) will develop symptoms of Post-Traumatic Stress Disorder (PTSD). Given the dramatic increase in ICU admissions during the COVID-19 pandemic, post-ICU PTSD is a relevant concern at the time of writing. Post-ICU PTSD can present various challenges to clinicians, and no clinical guidel...
Article
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Background: Over the last few decades, effective psychological treatments for posttraumatic stress disorder (PTSD) have been developed, but many patients are currently unable to access these treatments. There is initial evidence that therapist-assisted internet-based psychological treatments are effective for PTSD and may help increase access, but...
Article
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Background The identification of negative self-imagery as a maintenance factor in adult social anxiety has led to enhanced treatments for this population. Whilst intrusive negative imagery is commonly reported by socially anxious adolescents, no studies have demonstrated that it plays a causal role in maintaining symptoms. To assess this possibilit...
Data
Supplemental Materials for: Wiedemann, M., Stott, R., Nickless, A., Beierl, E. T., Wild, J., Warnock-Parkes, E., Grey, N., Clark, D. M., & Ehlers, A. (2020). Cognitive processes associated with sudden gains in cognitive therapy for posttraumatic stress disorder in routine care. Journal of Consulting and Clinical Psychology. https://doi.org/10.1037...
Article
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Objective: Although most studies investigating sudden gains in treatments for posttraumatic stress disorder (PTSD) report a positive association between sudden gains and outcomes at the end of treatment, less is known about sudden gains in routine clinical care and the processes involved in their occurrence. This study investigated changes in cogn...
Article
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Standardised role-plays (SR) have been proposed as an alternative to recordings of patients' therapy sessions (PTS) to assess therapist competence during CBT training. This study compared the following properties of SR assessments with established PTS assessments: interrater reliability, responsiveness to training, convergent validity of competence...
Article
Full-text available
Background: Adolescent social anxiety disorder (SAD) is common, impairing and persistent. There is a need to intervene early to avert its long-term consequences. Cognitive Therapy for SAD is the leading treatment for adults and shows promise for adolescents. However, given the scale of the problem of adolescent SAD and the limited availability of...
Article
Full-text available
Cognitive models suggest that social anxiety disorder (SAD) is maintained through the use of safety behaviours. Previous reports propose that these safety behaviours can be subdivided into two main categories: avoidance and impression management. Study 1 investigates whether certain safety behaviours are specific to SAD. The social behaviour questi...
Article
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Background Individual differences in cognitive responses to trauma may represent modifiable risk factors that could allow early identification, targeted early treatment and possibly prevention of chronic posttraumatic stress disorder (PTSD). Ehlers and Clark's cognitive model of PTSD suggests that negative appraisals, disjointed trauma memories, an...
Preprint
Full-text available
Background Adolescent social anxiety disorder (SAD) is common, impairing and persistent. There is a need to intervene early to avert its long-term consequences. Cognitive Therapy for SAD is the leading treatment for adults and shows promise for adolescents. However, given the scale of the problem of adolescent SAD and the limited availability of ps...
Article
Full-text available
Introduction Many patients with psychosis experience everyday social situations as anxiety-provoking. The fears can arise, for example, from paranoia, hallucinations, social anxiety or negative-self beliefs. The fears lead patients to withdraw from activities, and this isolation leads to a cycle of worsening physical and mental health. Breaking thi...
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The continued effectiveness of in-service psychological therapy training requires evaluation. This study assessed therapist competence and patient clinical outcome during cognitive behaviour therapy training and 12+ months post-training. Trainee competence was assessed using audio-recorded sessions rated on the Cognitive Therapy Scale Revised at th...
Article
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Background: Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental health care. However, this can only be achieved if results of tightly controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on devel...
Article
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Background The cognitive process of worry, which keeps negative thoughts in mind and elaborates the content, contributes to the occurrence of many mental health disorders. Our principal aim was to develop a straightforward measure of general problematic worry suitable for research and clinical treatment. Our secondary aim was to develop a measure o...
Article
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Despite increasing use of social media and the potential benefits for people with social anxiety (SA) disorder, little is known about the online experience of people with SA. Our study aimed to investigate the occurrence of cognitive and behavioral processes during a series of online and off-line Facebook (FB)-based tasks among individuals with hig...
Article
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Background There is international interest in the training of psychological therapists to deliver evidence-based treatment for common mental health problems. The UK Improving Access to Psychological Therapies (IAPT) programme, one of the largest training initiatives, relies on competent therapists to successfully deliver cognitive behaviour therapy...
Preprint
Background Adolescent social anxiety disorder (SAD) is common, impairing and persistent. There is a need to intervene early to avert its long-term consequences. Cognitive Therapy for SAD is the leading treatment for adults and shows promise for adolescents. However, given the scale of the problem of adolescent SAD and the limited availability of ps...
Article
Full-text available
Background Persecutory delusions are a major psychiatric problem and are associated with a wide range of adverse outcomes. Our theoretical model views these delusions as unfounded threat beliefs which persist due to defence behaviours (e.g. avoidance) that prevent disconfirmatory evidence being processed. The treatment implications are that patient...
Preprint
BACKGROUND Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental healthcare. However, this can only be achieved if results of tightly-controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on develop...
Article
Full-text available
Social anxiety disorder is a condition characterised by a marked and persistent fear of being humiliated or scrutinised by others. Age-of-onset data point to adolescence as a developmentally sensitive period for the emergence of the condition, at a time when the peer group becomes increasingly important. Social anxiety in adolescence is associated...
Article
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BACKGROUND: The CONSORT (Consolidated Standards of Reporting Trials) Statement was developed to help biomedical researchers report randomised controlled trials (RCTs) transparently. We have developed an extension to the CONSORT 2010 Statement for social and psychological interventions (CONSORT-SPI 2018) to help behavioural and social scientists rep...
Article
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BACKGROUND: Randomised controlled trials (RCTs) are used to evaluate social and psychological interventions and inform policy decisions about them. Accurate, complete, and transparent reports of social and psychological intervention RCTs are essential for understanding their design, conduct, results, and the implications of the findings. However, t...
Article
Empirically supported psychological therapies have been developed for many mental health conditions. However, in most countries only a small proportion of the public benefit from these advances. The English Improving Access to Psychological Therapies (IAPT) program aims to bridge the gap between research and practice by training over 10,500 new psy...
Article
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PurposeNational initiatives, such as the UK Improving Access to Psychological Therapies program (IAPT), demonstrate the feasibility of conducting empirical mental health assessments on a large scale, and similar initiatives exist in other countries. However, there is a lack of international consensus on which outcome domains are most salient to mon...
Article
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Background: Internationally, the clinical outcomes of routine mental health services are rarely recorded or reported; however, an exception is the English Improving Access to Psychological Therapies (IAPT) service, which delivers psychological therapies recommended by the National Institute for Health and Care Excellence for depression and anxiety...
Article
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The effectiveness and mechanisms of psychotherapies for PTSD in treating sleep problems is of interest. This study compared the effects of a trauma-focused and a non-trauma-focused psychotherapy on sleep, to investigate 1) whether sleep improves with psychotherapy for PTSD; 2) whether the degree of sleep improvement depends on whether the intervent...
Article
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Mental health problems are inseparable from the environment. With virtual reality (VR), computer-generated interactive environments, individuals can repeatedly experience their problematic situations and be taught, via evidence-based psychological treatments, how to overcome difficulties. VR is moving out of specialist laboratories. Our central aim...
Chapter
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This treatment is based on a developmentally sensitive adaptation of Ehlers and Clark’s (2000) model of PTSD, empirical evidence and our own clinical experience. Central to this model is the experience of a sense of current threat despite the fact the traumatic event happened in the past and which arises from two sources: