Self-injurious behaviour in people with learning difficulties has been found to be a common and health-threatening problem. As a consequence, there is an expanding literature addressing a variety of methods of intervention that are either designed to facilitate or to enforce the reduction or extinction of such behaviour. It is not clear, however, the extent to which such interventions are successful in achieving their avowed goal. This paper critically reviews the treatment of self-injurious behaviour, including work which takes psychodynamic, psychopharmacological, developmental, self-stimulation or learned behaviour perspectives, in order to establish the current status of interventions in this area. It is concluded that no single treatment approach has been shown to be effective in facilitating a reduction in the self-injurious behaviour of all clients. Rather, individualized programmes of intervention need to be constructed, using careful causal and functional analyses of behaviour. Moreover, such programmes, which may be multi-modal in nature, need to aim for interventions that are minimally or non-aversive.

This paper describes the use of cognitive behaviour therapy (CBT) with 24 chronically depressed in-patients. These individuals had previously failed to respond to all other standard antidepressant treatments and had been persistently depressed for at least two years. The clients were divided into two cohorts. The first (n=8) received a standard CBT package of 15 sessions combined with pharmacotherapy. The second cohort received a combined treatment, but the style of delivery of CBT was changed to try to take into account the special needs of the client population. At 12 weeks, 70% of the second cohort of clients showed a greater than 50% change on their pre-treatment objective and subjective depression ratings. The implications of these findings are discussed and further therapy trials in this difficult-to-treat population are encouraged.

This paper builds on the suggestions of Samson and McDonnell (1990) concerning functional analysis and challenging behaviour and argues that although presenting an excellent outline of the general use of functional analysis, Samson and McDonnell (1990) have failed to sufficiently address the complexities of a functional approach to complex behaviour. The present paper emphasizes the need for caution when including “unobservables” in a functional analysis and discusses the contextual nature of the functional relationships between variables.

Samson and McDonnell (1990) proposed a definition of the term functional analysis. In a reply to that article, Jones and Owens maintained that Samson and McDonnell had failed to address sufficiently the complexities of this approach, particularly in the use of unobservables in functional analysis and the contextual nature of challenging behaviours. This paper attempts to provide a short reply to these contentions.

This paper responds to the comments of McDonnell and Samson concerning the Jones and Owens article which raised some issues related to the use of functional analysis in challenging behaviour. It is concluded that there is considerable agreement between the authors of both papers. The present paper raises some brief questions concerning the issues of a “correct” functional analysis and discusses dispositional characteristics in functional terms.

547 patients admitted to the medical wards of a general hospital in South West England completed a computer-administered health behaviour screening questionnaire. This included a retrospective week's drinking diary and questions about alcohol-related problems. All patients were shown, via the computer, a summary of their own week's drinking in comparison with nationally recommended upper limits for safe drinking. In addition, all those who were considered to be risk drinkers on the basis of consumption or problems (23% of males, 7% of females) were advised via the computer to reduce their consumption and were given an approved self-help manual. All risk drinkers and a proportion of others were asked to complete the same questionnaire six months later. Seventy-five per cent of those asked, did so. The computer screening procedure was well accepted into ward routine and a simple before and after comparison showed a slight but significant reduction in drinking risk for the group as a whole. Regression discontinuity analysis showed that computer advice to reduce consumption plus provision of the self-help manual was of no additional benefit in helping patients reduce drinking risk.

Two patients with florid symptoms and severely disturbed behaviours were treated with a cognitive-behavioural programme. The programme aimed to facilitate the patients' and their carers' ability to adaptively cope with the distress generated by the patients' florid symptoms. Both patients actively co-operated and responded with a marked reduction in symptoms and behavioural disturbance.

Using an ABA design, the impact of the unexpected delivery of Irn Bru to an out-patient clinic for depressed men was investigated using the Montgomery-Åsberg scale for depression. A significant improvement in both behaviour and affect was seen immediately, some benefit still showing at one month follow-up. The effect of the procedure on the multidisciplinary team is also discussed. Some methodological issues, including small sample size are explored. Despite the methodological problems the serious element of the study points to the important impact of unexpected, non-therapeutic elements on clinical behaviour, possibly as a result of the challenge to the therapist-patient relationship.

A 68-year old female with a phobia of choking on fluids was treated first with exposure in vivo and then with cognitive therapy. The exposure increased her water drinking to some extent, but the cognitive change was negligible. However, the cognitive therapy led to a dramatic change in the catastrophical misinterpretations and a fourfold increase in her water consumption. The effects of treatment were maintained at a 1-year follow-up.

A cognitive-behavioral treatment package aimed at alleviating trichotillomania, or hair-pulling, is presented. It consists of habit reversal and stimulus control to control hair-pulling, and relaxation, cognitive techniques, and role-play to manage the stress that often exacerbates pulling. Relapse prevention is addressed. This program has been applied successfully with several clients.

One hundred and ninety two students from schools and university rated the acceptability of treatments for anorexia nervosa as presented in written vignettes. Psychologically-based treatments, such as counselling and behaviour therapy, were rated more acceptable than drugs; flooding occupied an intermediate position. Context variables such as problem severity and outcome did not significantly effect treatment acceptability.