The present review concerns the relative efficacy of imaginal and in vivo flooding in the treatment of debilitating fear. It has generally been concluded that in vivo flooding is superior to flooding in imagery. However, in the present review, serious methodological weaknesses were found to exist in a number of studies which have been frequently cited as demonstrating the superiority of in vivo flooding. In addition, recent empirical studies are reviewed which cast doubt on the belief that in vivo flooding is superior to imaginal flooding. Overall, little support was found for recent recommendations advocating the abandonment of methods of imaginal exposure in the treatment of clinical fear.

Research and service-oriented studies are reviewed to indicate issues and promising strategies for evaluation of field-based parent-training. The main areas which professionals and researchers must address themselves to are indicated. A variety of multiple-outcome measures are used. Skill development and transfer of skills to the natural environment remains a poorly evaluated area. Professional workers need to attempt more control in methodology, reporting practice and using research analyses. Researchers will have to direct study to assessing realiability and validity and developing practical instruments for widespread use. The implications of previous work are discussed. The emphasis of the paper is that direct observations of parents working in their natural settings should be the preferred means of evaluation.

Many of the clients being treated by behaviour therapists will also be taking benzodiazepines. The use of these drugs may interact with the problems presented to the behaviour therapist and complicate treatment. In addition the behaviour therapist may be asked to help in managing withdrawal in those who have become dependent on benzodiazepines. The evidence relating to the effects of these drugs and their withdrawal reactions is discussed and suggestions made as to how withdrawal might best be managed.

Although there have been a vast number of reports on training direct care staff in behavioural techniques, little work has been reported pertaining to elderly individuals. This paper describes how a method of constructing, implementing and evaluating individual plans – goal planning – was adapted for use with elderly clients. Direct care staff in a number of different establishments were trained in goal planning techniques with elderly clients and evaluations of their goal planning skills were made after training. Most trainees acquired the skills to an acceptable level and in the small sample studied, this was maintained at four month follow-up. Some measures of the effectiveness of the implementation of the goal planning and its maintenance after training are reported, and limitations of the training programme are discussed.

It is hypothesized that phobics have cognitive representations of phobic stimuli that are relatively lacking in detail and elaboration, and that this is reflected in imagery relating to them. In a study of verbal imagery for coping with a spider, the accounts of phobics were found to be briefer and to include fewer stages. In a study of stimulus imagery, vividness was separated into its two components of (a) awareness of the image and (b) degree of detail, following a similar distinction proposed by Klinger. Awareness, but not detail, was found to be greater in phobics, though the hypothesis of less detail in phobics was not confirmed. It is suggested that a lack of elaboration of phobic imagery is likely to impede anxiety reduction in imaginal desensitization, and to reduce the effectiveness of imaginal representations of coping behaviour.

This paper describes an attempt at retraining continence in elderly psychogeriatric patients using behavioural methods. Thirty patients across four wards were selected and divided equally into experimental and control groups. The experimental group underwent a training programme lasting a total of seven weeks whilst the control group continued with the usual nursing procedure.

The results showed no significant differences in frequency of incontinence between the different groups at the end of the programme. However, there were indications that a continence training programme is more likely to be beneficial to those patients who have a low level of incontinence rather than those for whom incontinence is a more severe problem. For these patients, those in the experimental group showed increased levels of incontinence after the training period compared to the control group.

The five papers which make up this special issue all reflect a feeling of guarded optimism about future applications of cognitive therapy in our clinical practice. A long way has been covered since the theoretical formulations of the early 60's, which led to the term “cognitive revolution” after Kuhn's (1962) exposé of how paradigm shifts occur in science. If there has been a revolution, it has been, on the whole, non-violent in spite of the sometimes shrill protests from the old guard. As Paul Salkovskis points out in the introductory paper, behaviour therapists have, perhaps paradoxically, been the most enthusiastic in coming to terms with the new paradigm. This coming to terms has involved experimental, theoretical and treatment studies. The areas covered have expanded steadily from depression and anxiety, to the obsessional disorders, the eating disorders, the phobias, adolescent problems and, as seen in this volume, to pain and marital conflict. Articles, books and new journals proliferate. Why should that be so?

The successful treatment of faeces retention in a 6-year-old boy is discussed in the light of recent findings in the literature which suggest the need to take both family and therapist variables into account when training parents in child management skills. Details are given of the family variables considered relevant to the presenting problem in this case: lack of paternal motivation to co-operate in treatment, maternal depression and social isolation, and problem behaviour in a sibling. The treatment plan designed to take account of these variables is described, as well as the problems (and their resolution) encountered in implementing it. Successful outcome was maintained at three and six month follow-up. It is argued that wider use of this model of an expanded case study would provide useful hypotheses for future research, as well as clinical relevance for other practitioners.

Cognitive behavioural treatment for chronic pain was individually tailored based on pre-treatment assessment of the subjective pain experience of each patient. Eight chronic pain patients completed the individualized treatment program which consisted of relaxation techniques, hypnotic deepening strategies, a relabeling hierarchy based upon pain descriptors, positive self-statements, didactic information, and cognitive-restructuring techniques. Patients self-monitored their pain during a two week pre-treatment baseline period, during the eight weeks of treatment and for one week post-treatment. Additional treatment outcome measures were also taken. Compared to baseline data, patients reported positive changes on many of the treatment outcome criteria, including McGill Pain Questionnaire indices, reduction in the number of hours spent in pain, and follow-up questionnaire responses. Treatment outcome measures collected at one week, six months, and 15 months post-treatment all suggested positive treatment gains. The greatest gains were reported at the six month post-treatment assessment suggesting a generalization or practice component to the therapy. Additionally, patients with constant pain were found more refractory to treatment than patients with intermittent pain.

The “Cognitive Revolution” has involved substantial changes in the emphasis of clinical practice and research interests of behaviour therapists. Work carried out in this area suggests that earlier fears about the potentially damaging effects of cognitive-behaviour therapy were unfounded. It can be argued that cognitive orientations have gained such widespread acceptance amongst behaviour therapists because the approaches are highly compatible at clinical and research levels, and because behaviour therapy had already started to incorporate similar concepts. Furthermore, cognitive models have also provided a wealth of new ideas and methods which considerably enhance behavioural approaches whilst leaving the fundamentals intact.

Five obsessive—compulsives who had previously benefited from individual behaviour therapy, but had subsequently relapsed, were included in 10-week group therapy programme designed to re-establish this behavioural approach with particular emphasis upon those factors which appeared to have been related to relapse.

Considerable reductions in ratings of ritualistic behaviour and obsessional thinking were achieved and maintained at one year follow-up, with associated generalization to other areas of personal functioning. Possible prognostic variables were systematically examined. The results are discussed with reference to previous research studies.

This study was designed to investigate the relative effects of two behavioral group treatments on short-term (knowledge and attitude change) and long-term (recidivism) variables among persons with multiple arrests for driving under the influence of alcohol (DUI). Subjects were randomly assigned to a behavioral treatment that was highly-individualized and focused on principles of self-control or to a general behavioral treatment (which focused on alcohol education, relaxation training, and guided reevaluation of situations typically associated with DUI arrests). Results showed that subjects in both groups reported, over treatment, a more frequent use of portable breath test devices for assessing blood alcohol levels and perceived an increased probability of being arrested if they drank and drove. In addition, subjects in the individualized behavioral groups reported that they subsequently spent more time thinking about avoiding DUI. However, the two treatment groups did not differ in their rates of DUI arrest recidivism (which averaged 11.7% per year over the three-year follow-up period). One third of the subjects were rearrested for DUI during the 36-month follow-up period, although there were indications that rearrests may have been delayed as a function of the treatment interventions. Taken together, the data suggest that these drunk-driving recidivists may be responsive to the treatment interventions described herein. Additional research is needed to specify the relative impact of the behavioral techniques utilized in the treatment programs and to identify strategies for maintaining treatment gains over longer periods of time.

Although covert conditioning procedures are widely employed by behavior therapists, the literature is marked by considerable procedural variability and inconsistent results. Part of the problem is attributable to the lack of a generally agreed upon and experimentally supported theoretical account of covert conditioning procedures. Inasmuch as the procedural arrangements of covert conditioning techniques depend upon the underlying theoretical framework, it is important that the framework be experimentally supported. One prominent theoretical account of covert conditioning is the operant account proposed by the main proponent of covert conditioning, Joseph Cautela. As an explanation of the clinical effects of covert conditioning, however, Cautela's account has not been adequately tested. Two experiments were conducted, the purpose of which were to conduct laboratory analogue tests of Cautela's account of covert conditioning by examining the effects of covert reinforcement and covert punishment procedures on the subsequent free-operant rate of selected target responses of college students. The results failed to support Cautela's operant explanation of covert conditioning.

Cognitive therapy for depression is well-established. However, it is only recently that Beck and his colleagues have turned their attention to the development of a cognitive therapy for anxiety. The present article provides a brief overview of cognitive therapy for anxiety and also presents outcome data on six anxious patients who were treated with cognitive therapy. Considerable reductions in anxiety and depression occurred during the course of treatment. In addition, much of the observed improvement occurred after as little as eight sessions. These results suggest that cognitive therapy is a promising approach to the treatment of anxiety disorders. However, final evaluation of its effectiveness must await the publication of large scale, controlled trials.

This study looks at the use of individual scaling techniques, namely the Personal Questionnaire Rapid Scaling Technique (PQRST) to monitor symptom change during a social skills group. This augments the more familiar observational measures and self report questionnaires. The results suggest that these individual questionnaires may be useful to clarify social interaction difficulties and the process of change in social skills training.

The effect of two treatments on a facial tic was examined experimentally. The subject, a 53-year-old male, carried out massed practice or relaxation for two periods of 5 min alternating with 5 min assessment periods during which he engaged in free conversation around key words. This was followed by a further two periods of the alternative treatment and intervening assessment periods. Pulse rate was monitored throughout and the procedure concluded with a 5 min period of covert assessment of tic frequency. Sessions were held on four consecutive days. Tic frequency was observed to increase following massed practice and marginally following relaxation. The latter treatment, however, was found to be effective in reducing tic frequency during the treatment block itself. The results are discussed in terms of the subject's general level of anxiety and the anxiety induced by the massed practice procedure.

A programme of research is described which investigates the cognitive processing of phobic stimuli. Phobics show good perceptual “pick-up” of phobic words on a version of the Stroop test. However, their encoding appears to be poor, as indexed by recognition memory for phobic stimuli. Consistent with this, cognitive representations of phobic stimuli are poorly elaborated and differentiated. Brief desensitization was found to have stronger effects on perceptual and encoding phenomena than on cognitive representations. Finally, spider phobics were found to have poor recall of phobic words. This contrasts with the opposite phenomenon that has been reported for agrophobics and depressives.

A 7-year-old hyperactive boy with multiple problems was treated using a combination of interventions, applied sequentially over 14 months. The first phase of treatment was participation in a drug trial (placebo, then drug) and this was followed by cognitive-behavioural training designed to teach strategies with which to approach academic work. Teacher and parent behaviour ratings showed improvement over the drug trial period and educational gains were made during the cognitive-behavioural training, both in the area specifically taught and other academic subjects. The problems choosing appropriate targets and of disentangling the effects of different treatment components are discussed.

The Hyperventilation Syndrome is a common disorder and clinical psychologists will be regularly confronted with it, because the syndrome is closely interwoven with psychological problems. The literature is reviewed with respect to pathophysiology of the complaints, aetiology of the syndrome and treatment. A new developmental model is presented and directions for future research are proposed.