Forty patients suffering from persistent psychophysiological Disorders of Initiating and Maintaining Sleep (DIMS) were assigned to one of the following groups: (1) EMG-biofeedback training; (2) cognitive modification treatment, combining paradoxical instructions, cognitive restructuring and thought stopping; (3) stimulus control and progressive relaxation treatment; (4) waiting list (control). Each active treatment consisted of six sessions over a period of 2 weeks.

After treatment, the patients in the three treatment groups showed shorter sleep onset latency (37%), shorter wake time after sleep onset (50%), and more positive evaluations of sleep quality and restedness on awakening in the morning. The waiting-list group did not show any changes. Benefits were maintained and further increased during the 1 and 3 year follow-ups. Results did not suggest substantial differences, among the three treatments, in amount and/or stability of benefits. The 3 year follow-up revealed seven failures, as against 23 successes. The initial variables differentiating the failures were shorter sleep time and higher scores on the P scale of the Eysenck Personality Questionnaire.

The present study examined the effects of therapist presence and the addition of relaxation training on the efficacy and generalizability of in vivo exposure procedures in the treatment of multiply-phobic individuals. Thirty-two individuals who were severely phobic of at least two objects/situations were assigned to one of three treatment groups or a waiting list control group, but received treatment for only one phobia. The Exposure Alone group received prolonged exposure to a phobic stimulus while alone in a room with that stimulus. The Exposure + Relaxation group were also exposed to a phobic stimulus but had received additional training in a relaxation technique. Subjects in the Exposure + Therapist group were accompanied by a nonanxious/nonavoiding “therapist” during exposure sessions. All treatment groups improved significantly, but the Exposure + Therapist group demonstrated significantly greater extinction of fear responses related to the treated phobias than the other groups. The Exposure + Relaxation group demonstrated the greatest generalization of treatment effects to untreated phobias. Clinical and theoretical implications are discussed.

The links between science, clinical practice and politics are not always evident to us. Recent changes in Eastern Europe have affected all areas of life, and serve as a reminder that such links between apparently separate areas can and do exist. Maria Kopp, who wrote the following article, is a Hungarian researcher and clinician who, despite considerable restrictions and lack of resources, has conducted a range of important studies into the nature and treatment of anxiety and psychophysiological problems and published important articles both in Hungarian and English (e.g. Kopp & Gruzelier, 1989; Kopp et al., 1986). In the following article, a version of which was publishec in the newspaper Magyar Nemzet (“Hungarian Nation”) on the 2nd October, 1989, she brings her knowledge of the processes involved in the origins and maintenance of anxiety to bear on present-day difficulties in the emergent eastern European democracies. In particular, she highlights the responsibility of those who are entrusted with control over others not to abuse their ability to provoke anxiety and engender helplessness. Dr Kopp also highlights the responsibility of those who place others in power to be aware of the potential danger of abuse, regardless of the declared good intentions of those who wield such power. Such considerations are not completely alien to our own situation.

Arousing anxiety is one of the most important instruments of tyranny. Arousing anxiety is a weapon used not only by dictatorial societies, but also by the dictators of the family, school, workplace or organization. The essence of anxiety is the inability to actively control situations perceived as threatening —the experience of this lack of control and the inability to avert the impending threat causes this situation. In the interest of preserving and strengthening their power, the person or group possessing crucial information is able to withdraw the possibility of control, or to portion it out as a reward; in this way anxiety is aroused in those affected. Arousing anxiety is not only an instrument, but can also be the essence of the exercise of power for its own sake. Tyrannical power wishes to ensure full freedom of decision for itself at all times and it therefore does not commit itself, not even in the form of an agreement serving its own interests. This is true for all relationships of dependency in which the more independent partner is able to withhold information, thereby keeping the other partner in a state of “loss of control”. If the plumber does not turn up at the time agreed and does not inform us of this beforehand, if the garage does not repair the car on the grounds of a shortage of spare parts despite the fact that they have parts, we are placed in a state of powerlessness. We encounter various forms of abuse of power and induced anxiety day after day, but do not pay sufficient attention to it, do not recognise it in its essence and do not understand how this slow-acting poison kills. However, we can also arrive at a psychological definition of freedom and democracy through an understanding of the essence of arousing anxiety and of anxiety.

Prompts are assessed in terms of their ability to convey an understanding of the task to those with a severe mental handicap. On this basis, it is suggested that the most effective strategy for teaching manipulative tasks to this group may be one which combines stimulus and response prompts. Two case studies compared this procedure with two procedures which used response prompts only. The combined procedure was more effective in both studies. The studies also demonstrated the applicability of stimulus prompts to teaching the motor, as well as the visual, components of manipulative tasks.

Teaching procedures encouraging the “errorless” acquisition of discriminations through the enhancement of criterion-related cues have proved popular and effective in work with individuals with severe learning difficulties. To date, however, their application has primarily been restricted to the learning of relatively simple discriminations, such as size and colour. The present study describes the successful implementation using two adults with severe learning difficulties of a teaching programme adopting this approach with respect to the skills of age and gender discrimination. Along with encouraging generalization and maintenance data, this success suggests that procedures involving the enhancement of criterion-related cues may have utility with a far broader range of tasks than previously considered.

This paper presents case studies of two boys who had problems forming friendships, and who participated in a group treatment designed to enhance their social skills. The intervention consisted of both behavioural techniques and cognitive problem solving strategies. The boys' improvement was reflected in some of the formal measures of change, and in reports from parents and teachers. The paper addresses issues concerning the role of assessment, and the selection of appropriate measures of change.