Cognitive processes are considered integral to the conceptualisation of emotional disorders and distress. Contemporary models have emphasised the importance of individual differences in the interpretation of internal events, including emotions. Maladaptive beliefs about emotional experience may motivate unhelpful control strategies, and impact negatively on psychological wellbeing. Building on existing measures of emotion, an integrative scale was developed to assess a range of maladaptive beliefs about the experience of negative emotions. Psychometric evaluation provided preliminary support for the reliability and validity of the Affect Intolerance Scale (AIS). Furthermore, the scale demonstrated a unique relationship with clinical symptomatology (i.e., depression, anxiety, stress and worry) above and beyond existing measures assessing dimensions of emotional experience. Potential utility of the measure for clinical practice and avenues for future research are discussed.

Cognitive behaviour therapy concentrates on strategies to assist clients in changing their thoughts and/or their behaviour. The aim of this paper is to discuss research findings from the addictions field indicating that an effective approach to therapy is to enhance motivation for change. Research into stages and processes of change, decision making, and motivational interviewing is reviewed. The paper concludes by suggesting ways in which this research can be used by therapists to increase the likelihood that clients will engage in change and maintain change over time.

The scientist-practitioner model remains valuable in improving the treatment of individual clients and in enhancing clinical science. One deterrent to its implementation, however, is the unsuitability of traditional research methods to clinical settings. Alternative research tools are presented, namely, practical ways to collect dependent measures, specification of treatment and measures of treatment integrity, and single-subject research designs.

Behavioural medicine has become a popular, important and distinct field of research and clinical practice. One of the more exciting areas of behavioural medicine has been in the application of behavioural techniques to reduce cardiovascular risk-factors on a community-wide basis. Work conducted in this area highlights a key issue for the development and support of behaviour analysis and modification activities in Australia: to what extent should behavioural practitioners and their interest groups pursue a specialised, behaviour-analytic approach to the areas in which they are involved, as opposed to adopting interdisciplinary frameworks and approaches. We describe some of the activities of the Stanford Center for Research in Disease Prevention, which has been able to operate as a large, interdisciplinary organisation, guided by behavioural approaches. We also discuss some setting, provider, program and client variables relevant to research and development on health promotion and disease prevention in Australia and elsewhere.

Stuttering is a speech motor disorder that begins in the first years of life and if not treated effectively can have catastrophic effects on the individual. This article briefly describes the disorder, and overviews treatment of stuttering in preschool children. Such treatment is considered far preferable to treatment in adolescence and adulthood. Evidence of the effectiveness of early stuttering treatment from clinical trials is overviewed, along with clinical benchmarks for such treatment. Epidemiological data showing considerable natural recovery are reviewed, and the implications of those data for the timing of early stuttering intervention are considered.

Much research has demonstrated that marital discord and divorce are risk factors for the development of childhood behavioural and emotional disorders. Although theoretical models and research programs that focus attention on possible mechanisms of influence are scarce, it is clear that marital discord can powerfully influence children via its effect on spouse's parenting behaviour. Thus, marital discord can represent a significant impediment for intervention programs that aim to help children by providing parent training. It is argued that marital and child focused interventions can be successfully integrated in behavioural family therapy. A description of the process and content elements of such an integration is presented, and future directions for research and practice are discussed.

The aim of this paper is to examine the treatment-outcome literature related to cognitive-behaviour therapy for depression in adults. Evidence for the effectiveness of cognitive-behaviour therapy is obtained from comparisons with waiting-list controls, non-specific controls, and other treatments, including pharmacotherapy. Short term effects are superior to those obtained with waitinglist controls, but are at least equivalent to pharmacotherapy. Longer term effects are difficult to evaluate due to methodological problems in such studies, particularly the lack of maintenance medication comparison groups. Nevertheless, the long term effects appear to be promising. Issues and data concerning the prediction and prevention of relapse are discussed. It is recommended that future research should focus on broader assessment goals and include cost-benefit analyses.

This article describes three studies that explore the relationship between headaches and the Type A behaviour pattern. The results of the first study demonstrated that in a student sample individuals who suffer from more fequent headaches and headaches of higher intensity have significantly elevated Type A scores. The second study complemented the first by showing that the majority of chronic headache sufferers displayed the Type A behaviour pattern; and the findings of the two studies together suggested that between 68% and 90% of chronic headache sufferers may be classified as Type A's. The results of the third study indicated that individuals whose headaches tended to be associated with negative affect (depression, anxiety, hostility, tiredness, confusion and unsureness) had significantly higher Type A scores than individuals whose headaches tended not to be associated with negative affect. It was suggested that the Type A behaviour pattern is a risk factor for headaches (as well as coronary heart disease and other disorders) as it resulted in the frequent experience of stress and negative affect which in turn could lead to headaches. Also, Type A individuals probably responded to headaches with more distress than those not exhibiting this behavioural style so that they were more likely to become trapped in the stress-headache spiral.

Fifty women with a history of breast lumps, and fifty control women matched for age and educational level, were administered a self-report questionnaire to determine knowledge of breast cancer, frequency and proficiency of breast self-examination (BSE), and health beliefs relating to BSE. Although women with previous breast lumps were more knowledgeable about breast cancer than those without, the two groups did not differ in attitudes or preventive behaviours. Overall knowledge of cancer and of BSE practice was low. This suggests a need for educational campaigns to increase knowledge and awareness, as a first step towards behaviour change, and a need for research to identify more effective predictors of BSE practice.

The investigators explored whether electromyographic (EMG) mediated biofeedback would help patients with cervico-brachial pain syndrome (CBPS) reduce muscle contraction and aid in pain relief. Twenty seven volunteer subjects with medically diagnosed CBPS were randomly assigned to two groups. The experimental group received EMG biofeedback mediated muscle relaxation of the neck for five, 40 minute sessions. The participants in the other group acted as "wait list" controls, and in turn, received treatment at the end of the study. Pre and post intervention measures consisted of EMG recordings of neck muscle activity; self-report measures of neck and general body relaxation, level of pain intensity, depression, anxiety and functional impairment. The results indicated that neck muscle activity, as measured by EMG, was significantly lower at the end of training. Associated with this reduction were a significant increase in self-reported neck and body relaxation and a significant reduction in the average intensity level of pain experienced by subjects over the pre to post intervention period. No changes were reported for the other measures.

Cognitive-behavioural family interventions for major mental disorder have undergone significant refinement over recent years. This paper reviews the current techniques for assessing mental disorder in the family. The initial task of the therapist is to undertake a comprehensive family assessment, including an assessment of their stress management. Specific information must be obtained about each family member's view of the presenting problems, interaction within the family system, and function in settings outside the family, as well as the family's effectiveness in problem solving and quality of life. Key goals of cognitive-behavioural family therapy are personal goal setting, education, and communication training that enhance the efficiency of family problem solving. The efficiency of cognitive-behavioural therapies in treating major mental disorders is also reviewed in relation to the family's ability to achieve specific goals in therapy and to modify the outcome of major mental illness. Particular attention is given to the strengths and weaknesses of the research, and to possible future research directions. Cognitive-behavioural family interventions are found to be effective in reducing clinical, social, and family morbidity.

Two case studies are described where in vivo practice was applied to needle phobia and associated vasovagal fainting. Substantial improvements in self-efficacy, anxiety and performance were obtained. Treatment gains generalised to other settings and were maintained at three to six months foliowup. In vivo practice is recommended for further research into needle phobias.

In the present study, responses of 197 people who were receiving chemotherapy at two outpatient clinics and who completed a questionnaire about the presence and origin of blood-injection-injury (BII) fear were examined. From this sample, 36 participants (18.9%) reported ‘strong feelings of fear, disgust or discomfort’ towards the sight of blood, receiving injections or both. Of the 36, 7 participants (19.4%) had first noticed these concerns while they were receiving chemotherapy, and a further 19 (52.8%) reported noticing them during a traumatic experience unrelated to treatment. A subgroup of 22 participants completed the Origins Questionnaire (Menzies & Clarke, 1993). Of these participants, 7 (31.8%) were classified as having an associative onset, and 6 (27.7%) were classified as nonassociative. Only 1 participant with an associative onset attributed the fear to trauma related to chemotherapy. From these data, it appears that while a large minority of the chemotherapy patients who completed the questionnaire experienced distress associated with blood and injections, in the majority of cases the onset of these fears was not attributable to trauma associated with chemotherapy.

Coercion is defined as the control of behaviour through (a) punishment or the threat of punishment, or (b) negative reinforcement — the removal of punishment. The question under discussion is whether coercion is an effective and a desirable basis for applied behaviour analysis, particularly in educational settings. Because coercive control has always been characteristic of society in general, the problem requires consideration of all facets of our culture. Behaviour analysts who use or recommend coercive techniques of therapy, behaviour modification, teaching, parenting, and so on, must be viewed in that context. In many areas of society, the practice of coercion has been refined and perfected to an extent that applied behaviour analysis has never approached. Applied behavioural research therefore contributes nothing new when it applies coercive methodology. Also, coercion produces side effects that may be even less desirable than the original problem behaviour. The occasional need to use coercion to deal with emergencies does not justify the advocacy of coercion as a principle of therapy. What basic and applied behaviour analysts can offer that is new and constructive are positive reinforcement techniques for teaching new behaviour and stimulus-control techniques for establishing cognitive repertoires.

Experiential avoidance (EA) has been connected to various behavioural indicators of psychological distress, implicated in the etiology and maintenance of psychological disorders, and is the target of prevalent psychological treatments. However, the reasons that individuals engage in dysfunctional EA are little understood. One hypothesis focuses on the preference for small, immediate rewards above larger, delayed rewards — in other words, impulsiveness. We examined the relationship of impulsiveness, measured both by self-report and behaviourally, to EA, while statistically controlling for possible confounding variables (i.e., intellectual functioning, gender, ethnicity), in a sample of normal undergraduate participants. Regression analyses suggest a significant relationship exists between EA and self-reported (but not behaviourally measured) impulsiveness. Exploratory analyses indicate nonplanning-type impulsiveness might be the best predictor of EA. Possible confounding variables did not account for a significant amount of variance within either model examined. Thus, support is provided for a theoretically proposed relationship within the Acceptance and Commitment Therapy model of psychopathology between EA and impulsiveness.

A case study is presented of a 13-year-old adolescent male with a long history of anxious symptoms related to school attendance. At the time of referral to the school refusal clinic, the adolescent had significant difficulty attending school, having attended for only 1 day in the past 3 weeks. A cognitive-behavioural treatment program was conducted over 3 weeks, consisting of seven sessions with the adolescent, seven sessions with his parents, and consultation to school personnel. Treatment focused on the implementation of behaviour management techniques by caregivers as well as teaching anxiety management skills to the adolescent. Positive treatment outcomes included the adolescent's return to full-time attendance at school as well as a decrease in emotional distress. The implications of treatment are discussed in relation to the simultaneous application of behaviour management and anxiety management strategies in the treatment of school refusal.

This study examined the effects of tactile stimulation on self-injurious behaviour (SIB) in a 10-year-old boy with developmental disabilities. SIB occurred at high rates during unstructured play, suggesting an automatic reinforcement, sensory stimulation function. Noncontingent application of an alternative source of tactile stimulation produced only modest reductions in SIB, but contingent removal of the objects used to obtain tactile stimulation produced clinically significant reductions.

This study developed and evaluated a puppet interview that allows children to self-report on temperamental constructs. Structured child self-report measures are rarely utilised in clinical assessment of young children under the age of 7—8 years. Given that clinical assessment is often characterised by low convergence between raters, such a measure may offer important contributions. The present study developed and evaluated a measure based on items from the Colorado Childhood Temperament Inventory and reports two studies with child participants aged 4 to 5 years. Independent observations of the children were also made. Results showed moderate levels of internal consistency and stability, and convergence between child self-report and teacher/parent raters was low, but similar levels of agreement were achieved between adult informants. The puppet interview thus showed some potential but highlighted the difficulties of self-report in young children within a multiple informant framework in clinical assessment.

The current article describes the psychometric properties of the Thought Control Questionnaire (TCQ; Wells & Davies, 1994) in 176 psychiatric inpatients at admission and discharge (352 completed TCQs). Factor analysis revealed four factors; Reappraisal/Distraction, Social Control, Punishment, and Worry. Scale descriptive statistics, reliabilities and correlations with psychiatric symptoms, self esteem, and quality of life supported the use of the TCQ in this setting. TCQ factors were then used as predictors of improvement from admission to discharge. The strategy of Punishment appeared to be unhelpful, with smaller reductions in the use of this strategy from admission to discharge predicting less improvement. Worry appeared to be an unhelpful strategy although the results were less consistent. The strategy of Reappraisal/Distraction appeared to be helpful, and greater increases in the use of this strategy from admission to discharge predicted greater improvement. Social Control also tended to be a helpful strategy although the results were less consistent. Overall, the results support the psychometric properties of the TCQ and are consistent with the notion that the use of certain thought control strategies may contribute to the maintenance of psychopathology while the use of others may contribute positively to treatment outcome.

The ACT (Acute Cognitive Therapy) Program was implemented as a patient follow-up initiative to respond to people presenting to emergency departments with suicidal behaviour or ideation, in a psychosocial crisis. Over 12 months 188 patients were referred to the program of which 160 attended at least one appointment and 109 completed the program. Pre- and postmeasures indicated that significant improvement occurred in those who completed the program, that improvements were maintained at 6 months and representation rates were reduced. Immediate short-term directed treatment appears beneficial in the short and medium term, and the rapidity and location of follow-up appears to promote compliance.