In order to test the efficacy of a self-help anxiety management package, sixty-two individuals meeting DSM-III-R criteria for an anxiety disorder were randomly allocated to one of three conditions: Stresspac patients were given a self-help/information package. Advice only patients were offered verbal advice on ways of coping with anxiety. 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 not seen until the end of this period when formal assessment took place. All patients were then followed through individual therapy and to 12 month follow-up. Results clearly support the superiority of the Stresspac condition after the waiting period, at post therapy and at follow-up on a range of measures. Possible explanations for the results are discussed.

The present study evaluates a multifaceted cognitive-behavioral group treatment in a routine clinical setting. The program consists of directly sleep related strategies such as sleep education, sleep restriction, stimulus control, relaxation, and cognitive restructuring. Also included are techniques that target illness maintaining factors such as stress-management, problem solving skills, and increase of activities. Twenty-eight physician-referred outpatients with chronic primary insomnia according to DSM-III-R criteria attended 11 weekly therapy-sessions. Results were obtained on a subjective and objective level using a sleep diary, questionnaires, and polysomnography, respectively. Pre- and post-treatment comparisons indicated significant changes on all main sleep diary variables, i.e. total sleep time, sleep efficiency, number of awakenings, sleep onset latency and wake after sleep onset, as well as for the global subjective sleep quality. Maximum improvement was reached after the more directly sleep-related part of the program. In addition, the intervention helped patients to reduce the amount and frequency of sleeping aids over time and improved their daytime-functioning. Subjective therapeutic gains were maintained at 3- and 12-month follow-ups. No significant treatment effects could be obtained on polysomnographic measures, taking into account that the baseline values were already in the normative range. After the intervention the patients were able to give a more realistic evaluation of their sleep. These results suggest that a multicomponent psychological treatment is beneficial for the improvement of sleep quality on a subjective level.

Twenty-four DSM-III-R non-depressed obsessive-compulsive (OCD) patients were compared to 21 normal subjects in three lexical decision experiments, to distinguish neutral, obsessive and responsibility words from pseudo-words. Error frequencies were comparable across groups. A significant taboo effect was found in both groups for obsessive and responsibility words. OCD patients did not differ from control subjects in their processing of neutral words and responsibility words. However, OCD patients were significantly slower than controls when processing obsessive words. Furthermore, OCD patients processed pseudo-words slower than controls if these were presented in the same experiment as obsessive words. When mixed with neutral or responsibility words, the performance of OCD patients with pseudo-words was similar to that of control subjects. The level of sub-clinical depression (as appreciated on the HAM-D scale) and psychotropic drugs (such as serotonin reuptake inhibitor) did not modify these results. Lexical decision performances were interpreted in terms of a cognitive disturbance triggered by obsessive stimuli that spreads to a neutral task. These results are compatible with the cognitive model of OCD (Salkovskis, 1985).

In an experimental study with panic agoraphobic patients, generalized anxiety patients and normals we operationally defined and measured spatial orientation of the three research groups. The observation, that patients suffering from agoraphobia have a very narrow exploratory activity range, is as important from the point of view of therapy as theory. Our study observed panic agoraphobic patients through their exploratory abilities. We examine panic agoraphobic, generalized anxiety and normal subjects, as they utilized their exploration skills in a complicated maze. We determined that the cognitive maps drawn by the panic agoraphobic patients are inaccurate. They got lost more often and utilized far fewer navigation points during their walk in the maze, compared to the generalized anxiety or normal subjects. The frame of the conceptualization was based on personal attentional strategies, spatial orientation deficit, and exploratory activity abnormalities.

The findings from this study indicate that group cognitive behavioural therapy combined with mood stabilizing medications was effective for some of the participants. Standard measures were used to monitor changes systematically and regularly. Self reports from participants suggested that they found the therapy useful and acceptable. The approach taken seems worth extending to a larger number of participants in a controlled trial, but meanwhile a detailed description of the treatment package is given, for wider dissemination of the methods.

One way of trying to minimize the problems arising from long waiting lists for psychological treatment is to see patients for assessment soon after referral, with the aims of making some contact, helping to reduce demoralization, and perhaps providing some practical coping advice. There is some evidence that such procedure may produce better outcomes in subsequent treatment, but also relevant is how people feel about these procedures and whether they meet patients' perceived needs. This paper reports some data on these questions. The data suggest that such an early contact procedure was strongly preferred by patients, but less strongly by therapists, particularly if the therapist treating a patient was not the same person who made the early contact. What patients liked about the early contact seemed to be mainly “non-specific” components such as reduced isolation and increased understanding. As such procedures seem to produce at least as good outcomes, and are preferred by patients, it is suggested that they should be the treatment of choice for clinics with long waiting lists.

Twenty-seven pain clinic patients referred for psychological treatment received Eye Movement Desensitization (EMD) as a major part of their treatment. Their progress was monitored using generalized measures with a three month follow-up. All patients responded to EMD in the session. Subsequently, nineteen completed treatment of whom twelve were successful and seven clear failures. Seven dropped out before completing treatment and one result was not clear. Overall the group showed a large decrease in some, but not all, psychological measures. There was some return of symptoms in the group over the three month follow-up. Neural networks are identified as the probable source of theoretical explanations of this procedure.

Panic, social phobia and agoraphobia are common problems, for which cognitive-behavioural interventions are particularly suitable. Walk Free is a comprehensive service for such sufferers, incorporating assessment by psychologists, home visiting, self-help activities, and support groups. It has expanded rapidly within Cardiff, where there are now four Walk Free centres, and it has seen over 300 sufferers over a three-year period.