This issue contains the obituaries of two of the greats in our field, and it is tempting to regard it as the end of an era. Hans Eysenck and Joseph Wolpe were truly giants in the field, truly founding fathers of scientific cognitive-behavioural therapy. Their passing is a landmark, but clearly not the end of an era. The era that they ushered in was one in which the basis of psychopathology and treatment lay in well defined theory and rigorous, well conducted research. That philosophy has grown, developed, and has given us a scientific basis for cognitive-behavioural therapy.

I believe that it is no coincidence that both men intended, at an early age, to follow a career in the physical sciences. They had many other characteristics in common, including a firmness of purpose that served both them and the field well. Isaac Newton, writing to Robert Hooke, said of his achievements that “If I have seen further it is by standing on the shoulders of Giants”. Eysenck and Wolpe were such giants, and we should be grateful for their shoulders, and for the vision that their achievements allow us.

Recent “Power Therapies” claim near miraculous cures but fare less well under controlled testing. These developments recall for cognitive behavior therapists the history of past “cures” that temporarily induced high levels of expectancies, but failed the test of time.

Childhood phobias are complexly determined but responsive to behavioral interventions. This review focuses on emotive imagery, a variant of systematic desensitization developed specifically for use in treatment of children’s excessive fears. Although emotive imagery appears to be a useful treatment procedure, further research is needed before it could be considered as having “well-established” empirical status. Several other important methodological and theoretical issues are emphasized.

The relative efficacy of cognitive restructuring and interoceptive exposure procedures for the treatment of panic disorder, as well as the differential effects of the order of these interventions, was studied. Eighteen clients with panic disorder were seen for four sessions of exposure therapy and four sessions of cognitive therapy in a crossover design study. Half of the participants received exposure therapy followed by cognitive therapy and for half the order was reversed. There was a 1-month follow-up period between the two interventions and after the second intervention. Questionnaire measures and independent clinician ratings were used to assess outcome. Participants expected greater benefit from cognitive therapy, but tended to improve to a similar degree with either intervention. The order in which treatments were presented did not influence outcome. Participants tended to improve with the first intervention and maintain improvement across the follow-up periods and subsequent intervention. Several methodological limitations qualify the conclusions that can be drawn from this study. These limitations, as well as some conceptual and methodological challenges of conducting this type of research, are discussed.

In order to test the efficacy of a self-help anxiety management package, 62 anxiety disorder patients were randomly allocated to one of three conditions. “Stress-pac” patients were given a self-help package, “Advice Only” patients were offered verbal advice on ways of coping. Patients in both conditions were seen on one occasion shortly after referral for assessment and management advice. They were then placed back on the waiting list for a three-month period. Patients in the “No Intervention” condition also completed measures during this time. They were formally assessed at the end of this period. All patients were then followed through therapy. Results from a previous paper clearly indicated the superiority of the Stresspac condition at all data points up to one year follow-up. This paper looks at three-year follow-up and, while finding generally good outcome across conditions, finds further evidence of the superiority of the Stresspac condition on a range of measures.

A six-year-old girl with surgically corrected imperforate anus and chronic faecal soiling was successfully treated by biofeedback. A portable biofeedback machine using an anorectal balloon was constructed and lent to the patient’s mother who administered the treatment at home following instruction in the clinic. Faecal incontinence was replaced by normal bowel evacuation habits after four weeks of the procedure. The effect was durable at least until follow-up at three months. Positive spin-offs were observed. The reversal of the child's encopresis suggested neuromuscular intactness of the anorectalregion despite the congenital malformation. Biofeedback probably compensated for an earlier learning fault. Domiciliary, parent-mediated biofeedback therapy is a cost-effective procedure and may be widely applicable to suitable patients within the population of children with primary expulsive and retentive bowel control disorders.

This preliminary study examined the short-term effect of a videotape intervention “Step-by-Step“ on 30 individuals referred with symptoms of panic disorder, before they had received any formal support from mental health services. It was hypothesized that a videotape intervention would reduce the symptoms and the frequency and strength of maladaptive cognitions associated with the consequences of having a panic attack, more effectively than the same information in written form. The results of this small scale study are promising. Some interesting trends were found within the video group, which provide some evidence to support the research hypotheses.

Behaviour change is often a desired outcome for carers and professionals who work with people with learning disabilities and challenging behaviours. Managing these behaviours in the short term is an important step towards this goal. This single case study presents the use of a low arousal approach in managing challenging behaviours in a young man labelled with severe challenging behaviour. This strategy focuses on the interaction of the carers with the client and how their approach has an important impact on the behaviour of the client. The study documents the incidents of challenging behaviour and shows a decline in their frequency from baseline over a one-year period. These gains were maintained at five-month follow-up. The implications for services of these findings are discussed.

Sensitization Alternating Desensitization (SADTM) is a revolutionary, Paradigm-Shifting approach for treating post-traumatic stress disorder and most other psychological and physiological problems. It has been clearly shown to be efficacious through anecdotal evidence and a complete lack of findings from controlled-outcome studies. (Satirical)

The study aimed to investigate why patients suffering from chronic schizophrenia discontinue psychological therapy. Patients who dropped out of a randomized controlled trial of cognitive-behaviour therapy and supportive counselling in the treatment of persistent positive psychotic symptoms were asked to complete a questionnaire on their reasons for doing so. Nine out of 12 patients who dropped out completed the questionnaire which consisted of 22 items that could be rated true or false. Although the size of the sample was small, the response rate was acceptable at 75%. The median number of reasons given was 7 (range 3 to 12), with the most common reason being that therapy was not perceived as suitable for the individual’s particular problems. The characteristics of the patients who dropped out are described.

Hans Eysenck may have been credited with being the father of behaviour therapy, but it is a claim he strenuously disputed. Rather, it would be more accurate to describe him as the midwife who assisted at a long and, at times, painful labour but which nevertheless produced a very healthy infant that has long since come of age.

In 1958, Dr Joseph Wolpe published a book (Psychotherapy by reciprocal inhibition) in which he not only claimed that it was possible to treat the symptoms of anxiety by helping patients to confront their fears, but also systematically to evaluate such effects. These suggestions were greeted with scorn by the psychoanalytic establishment, which maintained that symptomatic treatment that did not deal with the “cause’ of neuroses would inevitably result in “symptom substitution”. The prevailing view was that problems such as phobias were defences against deep seated conflicts, and that the removal of such symptoms would at best be ineffective, and at worst be harmful by destabilizing the patient's psyche. The notion that the effectiveness of psychotherapy could be scientifically evaluated in controlled studies was also rejected by analysts as irrelevant to their work. Forty years later the work instigated by this quiet, gentle and determined man has resulted in cognitive-behavioural therapy substantially replacing psychoanalysis as the psychological treatment of choice. Furthermore, Wolpe's view has passed into “common sense”, which now maintains that anxieties are best reduced by confronting them. His emphasis on controlled evaluation of the efficacy of the treatment he advocated anticipated current interest in “evidence based” approaches to mental health by more than three decades.