This pilot study describes the provision of information tailored to meet the needs of families caring for a chronic schizophrenic member. An existing education package (Smith and Birchwood, 1987) was adapted to give greater emphasis to negative symptoms, myths/stereotypes and “quality of life” issues. A range of outcome measures revealed that the “original” education package promoted a greater reduction in the level of family burden whereas the “modified” package tended to promote greater belief in the efficacy of medication. Both educational programmes were associated with significant gains in knowledge per se (but not in “functional knowledge”) and significant positive changes in families' beliefs about their own role in the treatment process. The implications of these findings are discussed.

Previous studies have shown that when normal subjects are instructed to think of a white bear (“forced” expression instructions), they do so more frequently when they have previously suppressed the thought of a white bear than when they have not suppressed this thought. It has been proposed that this rebound effect of thought suppression provides a laboratory model for the development of real-life obsessions. The present studies were undertaken in order to explore further the tenability of this model. Rebound effects were evaluated when more “liberal” expression instructions (“you might think of a white bear, but you don't have to”) were used. In Experiment 1, no evidence was obtained to suggest that suppression results in a heightened frequency and/or accelerated rate of white bear thoughts during a subsequent expression period (with “liberal” instructions). Interestingly, initial suppression lead to an immediate and stable increase of thought related electrodermal fluctuations. In Experiment 2, it was found that successful suppressors (few target thoughts during suppression) report fewer white bear thoughts during expression (with “liberal” instructions) than unsuccessful suppressors (many target thoughts during suppression). Assuming that the ecological validity of “liberal” expression instructions is greater than that of “forced” instructions, the present findings cast doubt on the claim that the rebound effect mimics the etiology of obsessions. The findings also suggest that it may be the immediate counter-productive effects of suppression that are relevant to theories concerned with obsessions.

A series of observation studies on elderly demented patients were carried out in an attempt to devise a reliable instrument for measuring engaged behaviour and emotional responses. This was achieved in a number of stages, and a final small scale study demonstrated a high level of inter-rater reliability. The instrument was then employed to assess the effects of a short-term intervention in a group of non-verbal elderly patients on a geriatric ward. A single case design was employed and replicated across six subjects. The results provide some support for the efficacy of this type of intervention, although there was considerable inter-subject variability in response.

Young males with alcohol-related offending behaviours were recruited into a research study. In a Young Offenders' Institution, pre-release offenders were allocated to a behavioural Alcohol Education Course (AEC) or a non-intervention control group. At follow-up, dependent variable differences were observed between the two groups. Results are discussed in the context of policy and practice.

Referrals for young males with drink-related offending behaviours were obtained from local courts. Following an assessment interview, young offenders completed either a talk-based Alcohol Education Course (AEC) or a behavioural AEC. At follow-up interviews, differences in dependent variables of offending and drinking behaviour were observed. The results are discussed in the context of their possible implications for practice.

In a recent questionnaire study Watts (1989) examined coping strategies including attentional and “self talk” strategies used by agoraphobics. This paper reports the findings of a revised coping with anxiety questionnaire administered to over 200 agoraphobic subjects to examine two issues raised by the Watts' study: firstly, the existence of discrete factors related to distraction techniques and focused attention to anxiety cues; and secondly, perceived levels of voluntary control in relation to different coping strategies. The results partially confirmed the factor analytic results obtained by Watts, although there was no evidence for discrete attentional factors related to distraction or calm focused attention. There was evidence consistent with the claim that self talk strategies are largely under voluntary control. The implications of the results for treatment are discussed.

Two branches of behaviour therapy will, I believe, dominate the course of events in the coming decade. The cognitive interpretation of behavioural problems (and cognitive solutions) can be expected to expand and deepen. The infusion of cognitive analyses will broaden out from the established bases, the successes achieved in tackling depression and panic disorder, to encompass a wide range of psychological problems. (The need for a coherent and efficient cognitive behavioural psychology will be particularly acute when the current infatuation with biological psychiatry wanes.) This expected expansion will then merge with the other development, the slow (too slow indeed) but steady growth of behavioural medicine. In truth, behavioural medicine, conceived as the application of psychological science to medical problems additional to the psychiatric ones, has been retarded by institutional and intellectual obstacles. For economic and scientific reasons there is likely to be an acceleration of progress in the next decade, and the entire process will, or should, be enriched and enlivened by the introduction of a more cognitive approach to behavioural medicine.

Momentary time sampling (MTS) is described as an unbiased method of estimating time spent engaging in target behaviour. Conclusions that MTS with long sampling intervals or for short sessions results in large error are based on studies which use too few observations (a too-small sample size) to expect small sampling error. Partial interval (PI) sampling is a biased method, and the degree of bias changes as the characteristics of the behaviour change, a particular problem for intervention studies.

While Cognitive Behavior Therapy (CBT) has been widely used for treatment of childhood disorders, the process underlying the success of CBT in this area is still unclear. This paper attempts to examine empirically the above issue, using the literature from 1974 to 1989 to see whether there is support for the underlying changes in cognitive processes that are assumed to mediate the therapy. The results show that while CBT is relatively effective in treating some childhood disorders, there is little empirical evidence to support the underlying cognitive models of childhood disorders.

Memory disorders feature amongst the most common complaints following brain injury. Theories of recovery and data derived from cognitive rehabilitation studies indicate that restoration of function is not a realistic goal, but recent work suggests that memory disordered patients often retain residual learning capabilities that can be utilized in teaching them certain kinds of information of practical use. This paper describes encouraging results obtained in teaching a patient computer related information by the method of vanishing cues. The patient learned more rapidly with this method than with anticipation learning, he showed evidence of good retention and, in contrast to earlier studies, he showed some evidence of generalization. However, the method may not be effective for all patients.

The theoretical and empirical basis of commonly accepted propositions concerning the role of behaviour in the practice of behavioural psychotherapy for anxiety problems is considered. A number of problems are identified, and an alternative, more explicitly cognitive hypothesis is described. According to this cognitive account, there is both a close relationship and specific interactions between “threat cognitions” and “safety seeking behaviour”. For any individual, safety seeking behaviour arises out of, and is logically linked to, the perception of serious threat. Such behaviour may be anticipatory (avoidant) or consequent (escape). Because safety seeking behaviour is perceived to be preventative, and focused on especially negative consequences (e.g. death, illness, humiliation), spontaneous disconfirmation of threat is made particularly unlikely by such safety seeking behaviours. By preventing disconfirmation of threat-related cognitions, safety seeking behaviour may be a crucial factor in the maintenance of anxiety disorders. The implications of this view for the understanding and treatment of anxiety disorders are discussed.

The argument is presented that behavioural psychotherapy has long been infiltrated by cognitive ideas, whether at the level of underlying philosophy, assessment or practice. For example, none of the traditional laws of learning have withstood the test of time, but although modern learning theory has had to become increasingly cognitive, behaviour therapists have yet to integrate these advances into a better understanding of therapeutic techniques and practice. Examples are also presented of a range of cognitive tasks that may provide further insights into the nature of the affective disorders.

This study presents the results of a preliminary investigation into the effectiveness of treating people with obsessive compulsive disorder (OCD) in group. Twenty-four clients in four groups run consecutively participated in the study. Outcome measures of statistical and clinical significance suggest that specific effects on the reduction of OCD symptoms were small. However, important positive non-specific effects were achieved relating to enhanced mood, reduction of the disabling effects of the symptoms, and clients self reported increased sense of hope, understanding and control. Initial improvements were maintained at six month follow-up. Clients' rating of helpfulness for the different contents of the group programme were highest for non-specific aspects. The author suggests that the presented group programme may have an important pre-treatment role in helping OCD clients prior to individual therapy.

Ten elderly patients with anxiety problems were treated individually using cognitive-behavioural interventions. These involved helping the patients reinterpret their anxiety symptoms in a non-threatening way. Questionnaire and self-report data suggested that cognitive-behavioural therapy may be an effective intervention for elderly patients with anxiety problems.

The ability of health locus of control, causal attributional, and secondary symptom variables to predict response to an integrated behavioural and psychodynamic treatment of agoraphobic in-patients, both immediately and one year after treatment, was investigated (N = 36). It was hypothesized that patients who retained an external locus of control during treatment would be likely to relapse after treatment. Further, it was hypothesized that tendencies to externalize locus of control, to attribute bad events to internal, stable, and global causes, and to attribute good events to external, unstable, and specific causes, would influence the treatment process in a negative way. It was also hypothesized that high levels of secondary symptoms, that is depression and general anxiety, would inhibit progress. None of these hypotheses were consistently supported by the results. This indicates that more precise and sophisticated models of agoraphobia development and treatment process are needed.

The present study evaluated the effectiveness of a multiple treatment approach to the group treatment of hypnotic and non-hypnotic taking insomniacs. Twenty subjects sequentially assigned into four groups attended weekly group therapy over a period of 11–13 weeks. Pre- and post-treatment comparisons indicated an overall improvement of the total sample on measures of general health, benzodiazepine related symptom reduction, reduction from hypnotic sedative medication as well as on measures of the quality and quantity of sleep. Overall there was a marked similarity between hypnotic and non-hypnotic users on the measures both before and after treatment. Psychological approaches are suggested as an effective alternative to the prescription of sedative-hypnotics to both recent and chronic insomnia sufferers. The implications of the findings are discussed.

This case study illustrates the reduction of severe stuttering by an individually tailored treatment programme. Interventions are derived from a tripartite analysis (Lang, 1971) and include EMG biofeedback, regulated breathing, exposure in vivo to stressful communication situations and cognitive techniques to reduce relapse risk. The role of dysfunctional response system interactions in stuttering is emphasized. Treatment resulted in a marked reduction of stuttering and associated facial contortions during videotaped conversations with strangers and oral reading. Improvement was maintained at one-year follow-up.

Adjuvant Psychological Therapy (APT), a cognitive behavioural treatment, has been developed to alleviate cancer-related anxiety and depression. It is being evaluated in a controlled study of patients with early cancer, but has not been used previously in patients with terminal cancer. This case report describes the use of APT in a severely anxious and depressed male patient with terminal carcinoma of the colon. His psychological progress until death is reported. Although no firm conclusions can be drawn from a single case, the results obtained were sufficiently encouraging to warrant a systematic study of APT in emotionally distressed patients with terminal illness.

The growing sophistication of behavioural psychotherapy is indicated by the progressive easing of service delivery for anxiety disorders. This is attained by emphasis on the patient doing systematic self-exposure and recording details of tasks completed in daily exposure homework diary sheets. Therapist-accompanied exposure is now known to be largely redundant. The clinician's chief role is to assess, guide and monitor progress and teach relapse prevention, rather than to be with the patient during exposure. A similar self-management model could develop for the relief of sexual, depressive and eating disorders. Further advance is needed to shorten the time and effort needed from sufferers to help themselves.