The hypothesis that elaboration of the phobic stimulus potentiates exposure in vivo treatment was put to the test in a clinical experiment. Forty-one female spider phobics, who applied for treatment, were randomly allocated to one of two conditions. In both conditions a 2.5 hour therapist-directed exposure treatment was given. In the elaboration condition Ss were required to attend to and describe the objective features of the spider constantly. In the non-elaboration condition the therapist tried to prevent this. A manipulation check suggested that Ss in the elaboration condition had indeed elaborated more extensively on the objective features of the spiders during exposure than Ss in the non-elaboration condition. However, Ss in the elaboration condition practised with somewhat fewer spiders than Ss in the non-elaboration condition, probably because of the time the elaboration took. Contrary to the hypothesis, elaboration did not potentiate either short-term or long-term effects of the exposure treatment. It seems superfluous to let patients elaborate on the phobic stimulus during exposure in vivo treatment: the processing of phobic stimulus information which is needed for an effective treatment seems to occur spontaneously when the patient engages in exposure in vivo exercises.

The present study investigated whether social support and family members' reactions to clients with obsessive compulsive disorder played a significant role in the follow-up outcome of an intensive behavioral treatment program. The roles OCD symptoms, moodstate, social functioning and life events were also assessed. General social support did not predict relapse, but significant others' empathy and positive interactions were associated with maintenance of gains. Negative family interactions (especially criticism and anger) and belief that clients could control their symptoms predicted relapse. Higher levels of post-treatment anxiety and depression and poorer functioning were related to negative outcome, as was distress from life events during follow-up. Results are discussed with respect to possible mechanisms of action and future research needs.

A long series of earlier studies demonstrated that fearful subjects selectively allocate attention to sources of perceived threat. Such attentional bias may not be limited to negative cues. It is hypothesized that attentional bias serves to enhance early identification of action-relevant cues and that such bias also occurs when subjects are confronted with positive valenced cues that evoke an urge to act immediately. In order to determine whether or not the attentional bias effect is limited to unpleasant stimuli, we studied the effects of 24 hours of fasting, focusing our attention on a possible attentional bias for (positively evaluated) food stimuli. The experiment controlled for emotionality effects. It is shown that fasting results in a positive evaluation of food stimuli and an increased desire for these stimuli. The attentional bias effects found were slight and more likely attributable to the increased urge to act than to general emotionality effects. The power of the experimental manipulation and the computerized Stroop task are discussed.

Recent years have witnessed the gradual emergence of a technology of nonaversive behavioural support for people with severe learning disabilities and seriously challenging behaviours. Three key aspects of these developments are reviewed, including: the functional perspective to analysis and intervention; the incorporation of the analysis and modification of setting events into behavioural practice; and the use of experimental techniques to conduct functional analyses of the contextual control of challenging behaviours. Attention is drawn to the practical implications and limitations of these developments.

The psychometric properties of the Compulsive Activity Checklist (CAC) were examined in a sample of obsessive compulsives (OCD), anxiety disordered (AD) patients, and non-psychiatric subjects (NP). All but 9 of the 38 CAC items significantly discriminated among groups, yielding correct classification rates of 71% when OCDs were compared with ADs and 84% when OCDs were compared with normals. Internal consistency alpha was high (0.95), but nine item-total correlations for OCD subjects fell below 0.40. A 28-item abbreviated scale (CAC-R) was developed based on the above findings. Preliminary analyses of the CAC-R on a normal sample indicated that this version is an improvement over the longer version and may be a viable alternative to the 18-item French one. It appears that the original CAC can be shortened with little loss of validity. However, substantial reductions may reduce the clinical utility of an instrument assessing a disorder with such widely diverse manifestations.

The present study evaluated the effectiveness of a self-help, cognitive-behavioural programme in the rehabilitation of a sample of chronic pain patients. The results demonstrated significant benefits for subjects who completed the self-help treatment on measures of depression, anxiety, coping strategies, impact on daily living, pain beliefs and self-monitored pain. These benefits were generally maintained at 6 month follow-up and no differences were found in outcome between subjects who completed the self-programme compared to those who completed the same treatment in a traditional clinic-based format. Unfortunately, a very high drop-out rate was found for the self-help condition, indicating the approach to be unsuitable for many clients. Attempts to identify the characteristics of subjects who completed the self-help programme versus those who dropped-out revealed only one predictor, namely pretreatment ratings of the credibility of the programme.

The anxiety-inhibiting properties of the prospect of vomiting were assessed and contrasted in 12 women with bulimia nervosa and an equal number of non-bulimic women. Subjects were exposed to a pleasant control scene and six food-related scenes in which they imagined eating standardized test meals with the knowledge that vomiting could or could not occur afterwards. The level of anxiety evoked by the scenes was assessed using subjective, behavioural and physiological measures. As predicted, bulimics reported that they would consume more of the meal when vomiting could occur after. No such difference was found for control subjects. However, the groups did not differ on subjective and physiological measures of anxiety. The results of the present study suggest that bulimics may utilize a hierarchy of control strategies to mediate the anxiety evoked by eating that may be amenable to cognitive-behavioural interventions.

Research using ambulatory monitoring and cognitive sampling procedures has revealed the importance of negatively biased cognitions in panic attacks and panic disorder. However, the normal population has never been investigated on the basis of these procedures and it is still unclear how patients deviate from them on the basis of negative cognitions and their interaction with affect and physiology. The present study investigated these issues by comparing 15 panic disorder patients with an equal number of normal controls. The results revealed that, although the pattern of reporting cognitions was similar, the two groups differed on type and content of the cognitions. In general, there were significant differences between the two groups for neutral and negative cognitions. Patients experienced high anxiety levels that were associated with cognitions of negative affect. There was a low frequency of reported panic attacks in the patients group. Possible reasons for the limited number of panic attacks are discussed.

The effects of education and stress reduction groups for the relatives of schizophrenic patients and their perception of services available to them is presented. 76% of relatives refused invitation to groups because they were overburdened. Those attending the groups said that they found them beneficial but measurable improvements were slight. Relatives' perception of the shortfalls of the services and the difficulties faced differed from that of patients. As the majority of patients turn to their relatives for help and support, rather than approaching hospital services directly, relatives were better able to identify service shortfalls. Patients' perceived needs included employment and increased income, which are not amenable to direct hospital intervention. Relatives were able to express needs that could be addressed by services. Both patients and relatives were able to identify the main difficulties faced, though there was a difference in emphasis.

The present study investigated whether information seeking coping styles (monitoring and blunting) affect exposure therapy outcome. Subjects were 33 spider phobics who received one 2.5 hours session in vivo treatment. In general, the treatment yielded good results. Coping style did not contribute substantially to short-term or long-term outcome (at 18 months follow-up).

Thirteen cases of Body Dysmorphic Disorder (BDD) were described. There were eight males (61.5%) and five females (38.5%) with ages ranging from 16 to 37 (mean=24.7). All patients were also diagnosed as obsessive compulsive disorder (OCD), according to DSM-III-R, with the exception of one. Patients were administered the Yale Brown Obsessive Compulsive Scale, Beck Depression Inventory, Wechsler Intelligence Scale, Over-valued Ideation Scale and MMPI. The Phenomenology of BDD, its relationship to OCD, and the patients' responses to the above tests were reported. Due to the bizarreness of the symptoms and the secretiveness of the patients, it was suggested that clinicians be thoroughly aware of the disorder and inquire as to its presence during the initial consultation. Otherwise, these patients go unnoticed and they resort to treatment from dermatologists and plastic surgeons.

The aim of this work was to test the comparative efficacy of four therapeutic modalities (self-exposure, self-exposure + Alprazolam, Alprazolam, and self-exposure + placebo) and also to determine the combined effects of self-exposure with Alprazolam and self-exposure with placebo in the treatment of agoraphobia without current panic. The sample consisted of 31 patients selected according to DSM-III-R criteria. A multigroup experimental design with repeated measures of assessment (pre-treatment, post-treatment and 1, 3 and 6-month follow-up) was used. The results indicated that there was a similar therapeutic improvement (in about 75% of the cases) between pre- and post-treatment in all therapeutic modalities, except for the Alprazolam group, where improvement did not take place, was rather weak or tended to fade as time passed. This improvement increased at the follow-ups in the self-exposure + placebo group, remained stable in the self-exposure group, and was irregular or fairly unpredictable in the self-exposure + Alprazolam group. There was a positive combined action between self-exposure and placebo and a negative interaction between self-exposure and Alprazolam. The highest relapse rate appeared in the therapeutic modalities where the active drug was administered. The intratreatment evolution was faster in the self-exposure group than in the others, but it tended to remain stable in the second part of the therapy. It is therefore concluded that the efficacy of self-exposure therapy may be the same if reduced to half the number of sessions. Finally, several topics that may contribute to future research in this field are commented upon.

Knowledge of the aetiology, epidemiology and treatment of nightmares has improved with more accurate definition of the problem. This review summarizes what is known about nightmares and their relationship with other medical and psychiatric disorders. Treatment methods are discussed, with particular reference to behavioural methods, which have become increasingly popular in recent years. Further research is suggested in order to determine the most efficient method of treating distressing nightmares.

Two cases involving the cognitive-behavioural treatment of hallucinations are described. In both cases, a focusing strategy was used with a view to enabling patients to reattribute the nature and meaning of their experiences. One patient showed a marked reduction in the frequency and content of his voices. The second patient showed little change. The implications of observations made during therapy for the future development of cognitive-behavioural strategies for use with psychotic patients are discussed.

This paper describes and evaluates the adaption of Behavioural Marital Therapy (BMT) to the needs of a couple in a secondary marriage (the husband was in his second marriage and brought three dependent children to this marriage). The couple presented with specific difficulties in negotiating parenting roles within the reconstituted family. BMT focused on promoting adaptive cognitions, affect and communication when discussing this specific issue. Evaluation used a multiple probe design assessing self-monitored stressful interactions about parenting, and daily marital satisfaction. Results showed significant reductions in the intensity and frequency of arguments from pre- to post-therapy, and increases in marital satisfaction. These gains were maintained at follow-up. Discussion focuses on future directions for adapting BMT to problems particular to secondary marriages.

Outpatients from a V.A. outpatient substance abuse treatment program (N = 32) were assigned at random either to receive or not receive a brief motivational intervention in addition to standard outpatient treatment. The additional intervention consisted of two additional hours of assessment and a one-hour motivational interview. Control subjects received the same additional assessment, but with an attention-placebo interview in place of the motivational interview. Those assigned to receive the additional intervention demonstrated superior clinical outcome at three month follow-up on a composite variable composed of three individual variables: (1) total standard drinks, (2) peak blood alcohol level, and (3) percent days abstinent. These results were substantially corroborated by reports of significant others. By six month follow-up, the superiority of the treatment group was modest, and no longer significant. These findings support the utility of this approach for use with clinically severe alcohol populations on at least a time-limited basis.

The purpose of this investigation was to examine the separate and combined effects of cue-controlled relaxation training and “aromatherapy” as treatments for reducing speech anxiety. Thirty-six speech anxious subjects were randomly assigned to one of four conditions: cue-controlled relaxation with a word cue, cue-controlled relaxation with an aroma cue, “aromatherapy” alone, and a wait list (i.e., control) group. Prior to treatment, subjects completed the Personal Report of Confidence as a Speaker, Fear of Negative Evaluation questionnaire, S-R Inventory of Anxiousness-Speech Form, Cognitive Somatic Anxiety Questionnaire, and Multiple Affect Adjective Check List; subjects also performed a speech which was rated for behavioral signs of anxiety. The assessment protocol was repeated following treatment, and at a two-month follow-up. Thirty-two of 36 subjects (89%) provided complete data at post-treatment, and 23 of 28 treated subjects (82%) provided complete data at follow-up. Results indicated that subjects in both cue-controlled relaxation conditions decreased their speech anxiety more than did the subjects in the aromatherapy or control conditions.

The paper presents a single case study of the treatment of primary encopresis in a 6 year old boy. The boy had never had regular bowel movements, suffered from retention for periods of 4–5 days, and soiled himself when he finally passed a bowel movement. The subject was treated using behavioural and cognitive techniques, and the progress was evaluated using a single subject design. The findings revealed that the intervention succeeded in stopping the boy's soiling and retention and in his achieving regular bowel movements. Two follow-up interviews after six and twelve months demonstrated that the improvement had persisted. The results suggested that the behavioural therapy package constituted an effective means for the treatment of encopresis.

Fisher's stepwise discriminant analysis was carried out on 10 baseline variables searching for posterior prediction of success in a sample of sixty DSM-III obsessive-compulsive patients. The patients' median score on Hamilton rating scale of depression was 19. In a controlled study they were randomized into three groups: fluvoxamine with antiexposure, fluvoxamine with exposure, or placebo with exposure. In the whole sample, five variables accounted for 76% of the correctly classified patients: avoidance score of the behavioural avoidance test, behaviour therapy expectations, fluvoxamine expectations, Beck depression inventory and rituals repetition. High avoidance score predicted 68% of the correctly classified patients in the whole sample. The discriminant function classified correctly 70% of the patients in the antiexposure with fluvoxamine group, versus 75% in the exposure with fluvoxamine group, and 85% of the patients receiving exposure with placebo (χ2, d.f.2, NS).