This article introduces a special collection of papers that discuss issues in training nonpsychologists and psychologists in behavioural and cognitive procedures. It is argued that while this has been a neglected issue, it is an important strategy in achieving the overall goal of the large-scale dissemination of cognitive-behaviour therapy (CBT), a stated aim of the Australian Behaviour Modification Association and like organisations. It is proposed that to successfully train nonpsychologists in CBT a number of conceptual issues need to be clarified. The first concerns the nature of CBT; it is argued that CBT is not an entity in itself, but the process of applying the science of psychology to human problems. Second, CBT knowledge is a continuum, with various levels of complexity. Therefore attempts to train nonpsychologists need to consider the trainees' level of psychological knowledge in determining the goals of training. Needs for (a) a comprehensive conceptual framework to guide the training of nonpsychologists, (b) research to identify the best ways of accomplishing training, and (c) “top-down” strategies, such as changing service-system philosophies, to complement the “bottom-up” strategy of training individuals, are highlighted.

Last (1983) defines public health as:

Recommended goals and targets for addressing national public health problems and directed at reducing the amount of death and premature death have been proposed in many countries over the past 10 years, including the United States of America (United States Department of Health and Human Services, 1990), the United Kingdom (Department of Health, 1992), Canada (Ontario Premiers' Council on Health, 1987) and Australia (Nutbeam, Wise, Bauman, Harris, & Leeder, 1993). In Australia for example, over the past 2 years, much attention has been directed at health outcomes related to cardiovascular disease, cancers, accidents and injuries and mental health. All of these reports have emphasised the importance of changing those lifestyle and related risk factors associated with preventable causes of death. Priority lifestyle areas that have been identified include physical inactivity, diet and nutrition, smoking, alcohol and other drug use, safety behaviours, sun protective behaviours, appropriate use of medicines, immunisation, sexuality and reproductive health, oral hygiene, and mental health. Priority populations and appropriate settings for intervening in these areas have also been identified.

This brief article introduces a two-part series of special issues of Behaviour Change on the cognitive-behavioural treatment of schizophrenia. Two pervasive myths about schizophrenia inhibit effective psychological treatment and rehabilitation: (1) that schizophrenia inevitably has poor outcome, and (2) that drugs are effective in the management of schizophrenia. Neither of these myths is supported by available data. A stress–vulnerability model is described which provides a framework for understanding the variability in outcome of schizophrenia, and for conducting cognitive-behaviour therapy.

The scientist-practitioner model remains valuable in improving the treatment of individual clients and in enhancing clinical science. One deterrent to its implementation, however, is the unsuitability of traditional research methods to clinical settings. Alternative research tools are presented, namely, practical ways to collect dependent measures, specification of treatment and measures of treatment integrity, and single-subject research designs.

This paper is a review of studies on psychological treatments for positive psychotic symptoms, and a detailed description of two of these studies, the Manchester Symptom Project, which aimed to decrease positive symptoms by training patients in effective coping strategies, and the Liverpool Auditory Hallucination project, which aimed to provide a cognitive-behavioural treatment for individuals with persistent and distressing voices. The results from these studies indicate that enduring positive symptoms which have not responded to neuroleptic medication can be effectively treated by psychological methods.

Plans are underway to commemorate the 20th birthday of the ABMA at the 17th National Conference to be held in Perth in 1994. Attaining such milestones usually prompts, in addition to ceremony and celebration, interest in history, roots, trends and resolutions for the future. There may be curiosity about what is being celebrated. It is easy enough to count back to the first National Conference in 1978 to arrive at the number 17, but the 20th birthday is not so obvious. My purpose here is to assuage that curiosity and give my version of the events that have followed.

It is argued that psychologists have an important role in ensuring appropriate training of medical students in behavioural and cognitive strategies. This paper outlines the innovative medical curriculum at the University of Newcastle and describes the contribution of cognitive psychology to the problem-solving method which underlies the curriculum. It also describes the medical school's approach to training students in interactional skills. One focus of the interactional skills training is to provide practical skills which incorporate behavioural and cognitive strategies to address common, preventable health problems, such as excessive alcohol consumption.

Physical inactivity is a risk factor for a number of chronic diseases, including cardiovascular disease. Interventions designed to reduce the prevalence of physical inactivity have focused primarily on either adoption of physical activity or noncompliance and relapse, and no interventions have been reported which cover adoption, compliance, maintenance, and relapse, particularly within the clinical setting. The Fresh Start program, a multiple risk factor intervention program for the reduction of cardiovascular disease risk factors in general practice patients, was developed to cover all aspects of the adoption and maintenance of habitual physical activity, using Prochaska and DiClemente's Transtheoretical model. The evaluation of the program on cardiovascular disease risk factors and behaviours provided the opportunity to evaluate the impact of a staged program on patient physical activity behaviour. The program was evaluated in a randomised controlled trial in Sydney's Western, South-western, and Wentworth regions with 80 volunteer general practitioners and 758 volunteer patients between January 1991 and January 1993. Self-reported physical activity data were used as the basis for estimating energy expenditure due to leisure-time physical activity. The results failed to show any differences between groups over time, as a function of patients' baseline stages of change, and as a function of baseline activity levels. There were some indications, however, that the least active would respond to doctor-based advice to increase their physical activity, and that doctor advice would lead to a progression in intention to change in approximately 20% of patients. Limitations of the study, the program, and physical activity intervention in the clinical setting are discussed.

Marital dissatisfaction is the most common presenting problem in adults seeking psychological services and is rated as the second most severe stress adults can experience after a death in the family. Almost every married couple is, at some time, at risk for marital distress, conflict, separation, and divorce and for the resulting stress on themselves and their children. Traditionally, theory and practice have focused on tertiary prevention of marital distress (i.e., marital therapies). However, marital therapy has limited efficacy and accesses only limited numbers of couples. Poor communication and dissatisfaction with interactions, assessed premaritally, are strong predictors of marital distress. Several marital distress prevention programs have been developed which generally or specifically target communication behaviour of pre- and early married couples. Outcome evaluations suggest such programs can lead to improved communication and problem-solving skills, improved relationship satisfaction, lower levels of marital violence, and diminished probability of marital dissolution. Suggestions for future research include a more fine-grained analysis of situation-specific cognition, affect, and psychophysiological responses during communication, incorporation of a self-regulatory model within prevention work, and the use of longitudinal research designs.

A primary health care community intervention program was offered to the middle-aged female population in a Swedish community aiming at reducing risk factors for cardiovascular disease. Around 30% of women with risk factors took active part in an intervention course program inspiring to lifestyle changes. Analysis showed few background differences between the group of women who participated and who did not participate in the intervention program. Most women with risk factors benefited from lifestyle changes, those with multiple risk factors to as large an extent as those with few risk factors for cardiovascular disease. Also women with risk factors who did not take part in the intervention course program changed their lifestyle habits to some extent.The pedagogics of the intervention program described in this paper are shown to be of value when addressed to middle-aged women with risk factors for cardiovascular disease.

Cognitive-behavioural family interventions for major mental disorder have undergone significant refinement over recent years. This paper reviews the current techniques for assessing mental disorder in the family. The initial task of the therapist is to undertake a comprehensive family assessment, including an assessment of their stress management. Specific information must be obtained about each family member's view of the presenting problems, interaction within the family system, and function in settings outside the family, as well as the family's effectiveness in problem solving and quality of life. Key goals of cognitive-behavioural family therapy are personal goal setting, education, and communication training that enhance the efficiency of family problem solving. The efficiency of cognitive-behavioural therapies in treating major mental disorders is also reviewed in relation to the family's ability to achieve specific goals in therapy and to modify the outcome of major mental illness. Particular attention is given to the strengths and weaknesses of the research, and to possible future research directions. Cognitive-behavioural family interventions are found to be effective in reducing clinical, social, and family morbidity.

Proponents of behavioural intervention have often advocated consultation as a means for disseminating behavioural innovation to nonpsychologists. However, experience suggests that the benefits of consultative arrangements are mostly localised, and that widespread dissemination is unlikely to be achieved through this process. The current “crisis in education” in the United States is given as an example of the limited effectiveness of dissemination through consultation. An alternative approach is examined, which aims to disseminate behavioural science knowledge to nonpsychologist practitioners during the formative stages of their professional education. This alternative, dissemination through foundation education, is illustrated by describing recent initiatives at La Trobe University. Several potential concerns that behaviour analysts may have about the dissemination of behavioural innovation to nonpsychologists are examined, including concern that behavioural scientists may lose their distinctiveness, the fear that behavioural scientists may be “giving away” valuable expertise, the conviction that behavioural scientists must retain control over behavioural innovation, the belief that dissemination will result in misuse of behavioural innovation, and the claim that it is futile to disseminate behavioural science knowledge because it is not valued by other health professionals. These various concerns were found to be unwarranted.

A survey was conducted of opinions of 24 psychologists in South Australia about the intrusiveness of 89 interventions including methods that might be used to reduce challenging behaviour. Interventions arose from a variety of sources, including behavioural psychology and medicine. Interventions might infringe on 8 different rights. Respondents rated the degree to which interventions were perceived to intrude on clients' rights, using a 4-point scale: abusive, very intrusive, intrusive, and not intrusive. A reasonable degree of consistency in ratings was found. Respondents did not rate all interventions that infringed on the same right as being equally intrusive. A number of interventions were rated as being intrusive but not abusive. Intrusive methods may be legitimate if properly authorised. The question arises of how decisions should be made to authorise intrusive methods when clients are unable to make decisions on their own behalf.

This article describes the Early Psychosis Prevention and Intervention Centre (EPPIC) — an innovative and comprehensive service that attempts to address the needs of older adolescents and young adults experiencing their first episode of psychosis. Some of the key theoretical concepts and philosophical tenets which underpin the service delivery model are adumbrated. Furthermore, the historical antecedents of the current service, and the “successive approximations” approach taken in developing the same, are delineated. Given the evolutionary nature of the program, the perceived future needs and developments are stipulated.

Effective applied behavioural intervention in teaching and learning settings requires a knowledge and skill base in human development, school curriculum, and cultural issues, as well as competence in the principles of applied behaviour analysis. Simple applications of operant principles to increasing on-task behaviour and work output have been very effective. However, behavioural practitioners in education now require a broader perspective on the interactive social contexts in which teaching and learning take place. This paper reviews a range of intervention strategies in the area of literacy learning which have been devised within this perspective, namely (a) antecedent discussion of context, (b) explicit modelling of competent performance, (c) responsive written feedback, (d) incidental teaching, (e) errors as contexts for learning, (f) Pause, Prompt, Praise, (g) reciprocal learning and peer tutoring. In conclusion, some of the implications for the training of educational professionals are examined.

National policy directions currently provide an environment in which mental health promotion activities can be widely supported in health and related arenas. Several recent national reports have identified the importance of primary care, especially in general practice settings, as the principal point of entry to the Australian health care system. A broad overview of the current policy climate prefaces a discussion of the opportunities for mental health promotion in the primary care sector, focusing on general practice settings and using depression as an example. Implications and consequences related to training of the mental health workforce, with special reference to roles for psychologists are discussed. Finally, recommendations are made for future directions in mental health promotion and prevention research in primary care.

General practitioners have been suggested as occupying a position in the community that offers considerable potential for reducing the prevalence of health risk behaviours. Green, Eriksen, and Schor (1988) have proposed that if general practitioners are to effectively adopt a role in modifying patient health risk behaviours, a number of prerequisite conditions must be met. Using the model proposed by Green et al., this paper reviews the literature to describe the circumstances under which general practitioners currently practise this role. The review focuses on the circumstances relating to practitioner modification of one patient health risk behaviour: smoking. Research detailing the extent of practitioner involvement in the modification of this risk behaviour is also reviewed. The paper concludes by discussing the opportunities available for behavioural scientists to facilitate general practitioners' adoption of a role in patient smoking cessation.

Schizophrenic patients seem to react sensitively to expressed affect. Expressed emotion research has shown the negative impact of specific family communication styles on the course of illness. This paper reviews and discusses related research on the therapist–patient relationship. Two studies by the author are presented. The first study is an examination of therapist rating of the therapist–patient relationship, the interaction between therapist's ratings and patient's psychopathology, and the prediction of the course of illness from therapist ratings. The second study assesses the therapist–relative–patient triad using EE measures, as well as dyadic assessment of the therapist–patient relationship.

Infant sleep disturbance (ISD) is widespread and troublesome. Although effective management techniques have been established, some lay and professional authors have expressed concern about these interventions. These concerns are sometimes shared by parents who seek professional advice while feeling ambivalent about undertaking treatment. These concerns include (a) that ISD is normal and inevitable, (b) that it results from unnatural or artificial cultural practices, (c) the belief that ISD expresses a need state, and (d) the belief that the use of extinction is harmful. These concerns are examined and the management of ISD by extinction and its alternatives are considered in the light of the ethics of professional practice. It is concluded that these concerns are best answered within the context of a professional relationship based on a partnership and the sharing of expertise with parents.

Behaviour therapists have always been optimists, and interdisciplinary involvement is a strong tradition in the behaviour therapy movement. While this increases the potential application of behavioural methods, it poses a substantial challenge for behaviour therapy trainers. This paper contends that if brief workshop training is used as the primary method of disseminating behaviour therapy skills across professions, it will provide an inadequate preparation, especially for higher levels of behavioural practice. In some circumstances, brief training may lead to an overestimation of behavioural skills by the trainees. The issues are discussed in the context of current moves toward multiskilling within health services. The paper contends that there is no substitute for ongoing training and consultation by senior clinical psychologists who are expert in behaviour therapy.