Behavioural medicine has become a popular, important and distinct field of research and clinical practice. One of the more exciting areas of behavioural medicine has been in the application of behavioural techniques to reduce cardiovascular risk-factors on a community-wide basis. Work conducted in this area highlights a key issue for the development and support of behaviour analysis and modification activities in Australia: to what extent should behavioural practitioners and their interest groups pursue a specialised, behaviour-analytic approach to the areas in which they are involved, as opposed to adopting interdisciplinary frameworks and approaches. We describe some of the activities of the Stanford Center for Research in Disease Prevention, which has been able to operate as a large, interdisciplinary organisation, guided by behavioural approaches. We also discuss some setting, provider, program and client variables relevant to research and development on health promotion and disease prevention in Australia and elsewhere.

The present study investigated the effectiveness of a cognitive-behavioural approach to the management of chronic work-related upper limb pain. Clients included three females who had experienced severe upper limb pain for 7, 3.5 and 1.5 years respectively and whose condition had been labelled by medical specialists as occupational overuse syndrome. Clients commenced treatment in a sequential manner, following a staggered baseline monitoring phase in order to produce a multiple baseline design across cases. Treatment involved 8 sessions over a 4-week period, covering pain management procedures, cognitive restructuring of maladaptive cognitions, relaxation training and EMG biofeedback. All cases showed some improvement in pain, distress and interference caused by pain. In addition, changes in depression, anxiety, coping strategies and sleep disturbance were reported. Therapy gains were maintained at the 6-month follow-up assessment for 2 of the 3 cases.

Cognitive-behavioural interventions developed from a variety of theoretical orientations have been demonstrated to be safe and effective treatments for unipolar depression. In this article, one specific intervention is described: the Coping With Depression (CWD) Course, a multi-modal group psychoeducational treatment. The theoretical rationale and development of the CWD Course is reviewed, as well as the specific course content. Evidence for the efficacy of the CWD Course is presented and discussed. Also described are several modifications of the CWD Course, developed for use with special populations such as depressed adolescents, caretakers of frail elderly, health-impaired Native Americans, and English and Spanish-speaking medical outpatients. Future research and development directions for the CWD Course are examined, including replication of outcome results, generalization to real-life clinical settings and to diagnostically co-morbid populations, and the prevention of depression among individuals at elevated risk of affective disorder.

Behavioural marital therapy (BMT) has developed from the application of social exchange and social learning theories to the understanding and modification of marital interaction. Encouraging high rates of exchange of positive behaviours, and training in communication skills, have been the major focuses of BMT till recently. While these strategies produce therapeutic change, there are still many couples whose marriages do not improve with this sort of therapy. Recent developments have focused on the role of cognitive, affective and situational variables in marital interaction. Outcome research has shown the value of cognitive and affective interventions in their own right, but it is unclear if the addition of these interventions will enhance the efficacy of BMT.

Our aim in this paper is to provide researchers and practitioners with a brief overview of current approaches to the assessment and treatment of dysfunctional communication in marriage. In our discussion of assessment, we examine four basic types of procedures: questionnaires, self-monitoring techniques, interviews and techniques involving the direct observation of interaction. We conclude that both insider (spouses' perceptions and interpretations gathered through self-report and self-monitoring) and outsider (direct observation of interaction) provide different but equally valid information about the relationship. Therapists and researchers are encouraged to use both types of information. Our discussion of therapeutic techniques includes the three major components of Behavioural Marital Therapy (BMT): Behaviour Exchange, Communication Training and Problem-Solving Training. We also focus on the importance of considering spouses' cognitions and emotional reactions, particularly those related to sex roles, when designing therapeutic approaches. Issues related to assessing the efficacy of therapy outcome are also discussed.

Research into the efficacy of cognitive behaviour therapy (CBT) has repeatedly demonstrated that it is a useful method for alleviating the symptoms of clinical depression. However, the underlying mechanism of the recovery process has remained a matter of debate in the literature. Although at no point in the literature has it been stated that cognitions ‘cause’ depression, this has been a strong implication in the design of many of the studies. The lack of consensus on the issue of causation is due partly to the lack of a co-ordinated approach to investigating the process of cognitive change and other variables in the depressive patient. Also the failure of many research designs to eliminate alternative hypotheses has led to confusion and debate about the direction which CBT research should take. The overall effect has limited the possibilities for an integrated model of depression. This paper looks at the various working models of depression in the literature and suggests the direction for future investigators' testing of these models.

Thirty men and women who regularly used minor tranquillisers and/or sedatives participated in a stress management group program, incorporating a behavioural self-management approach. They were assessed on questionnaire measures of anxiety, assertion and medication use in the first and final group sessions and at a 3-month follow-up. Data demonstrated declines in medication use during the course, which for many clients were maintained at the follow-up. These decreases were associated with decreases in anxiety levels.

This study investigated the effect of delayed reinforcement on the across-setting generalization of behaviour change. Eight children aged between 11 and 13, members of a special class at an intermediate school, served as subjects. Off-task behaviour was monitored during two classroom lessons: the contingent lesson, performance in which determined subsequent reinforcement, and the generalization lesson, in which no reinforcement contingencies were provided. Two forms of delayed reinforcement: early — delivered immediately following the setting in which the critical behaviour occurred — and late — delivered only after several other settings had been encountered — were sequentially presented in an ABCB design. Off-task behaviour decreased under both reinforcement conditions. However generalization was only evident when the late delayed reinforcement was operating. Results suggest that a temporal delay in the delivery of reinforcement is more likely to lead to generalization of behaviour change than is the delivery of reinforcement immediately following the contingent lesson.

Cognitive models of marital distress have received increasing attention. There are four major goals of this paper: (1) to review the prominent cognitive theories of marital distress and corresponding empirical data; (2) to provide theoretical integration; (3) to discuss the adjunctive use of cognitive interventions with behavioural marital therapy and outcome studies assessing the efficacy of cognitive clinical applications with couples; (4) to suggest future clinical and research directions.

This study involves the description of the presence or absence of several theoretically relevant skill deficits in 35 cases of depression. Until recently, most research and theory about depression has been based on the assumption that this is a homogeneous disorder with one determinant common to all incidences. Theories proposed by Beck (1967), Lewinsohn (1974), Seligman (Abramson, Seligman & Teasdale, 1978), and Rehm (1977) are examples of unitary theories. It is argued that a comprehensive account of depression must involve a multivariate theory such as that proposed by Staats and Heiby (1985). The case study involves a preliminary uncontrolled test of the hypothesis that there exist several skills deficits that may determine depression. The findings suggest support for the possibility that the following skill deficits deserve further investigation for their role in depression aetiology and treatment: logical errors including misattributions, poor self-control skills, poor social skills in terms of excessive aggression and deficit assertiveness, and inadequate hedonic capacity in terms of deficit positive interests and excessive negative interests (anhedonia). Suggestions for future research are offered.

The aim of this paper is to examine the treatment-outcome literature related to cognitive-behaviour therapy for depression in adults. Evidence for the effectiveness of cognitive-behaviour therapy is obtained from comparisons with waiting-list controls, non-specific controls, and other treatments, including pharmacotherapy. Short term effects are superior to those obtained with waitinglist controls, but are at least equivalent to pharmacotherapy. Longer term effects are difficult to evaluate due to methodological problems in such studies, particularly the lack of maintenance medication comparison groups. Nevertheless, the long term effects appear to be promising. Issues and data concerning the prediction and prevention of relapse are discussed. It is recommended that future research should focus on broader assessment goals and include cost-benefit analyses.

This paper discusses current issues in the literature on marital violence. Issues in three areas are discussed from a research and clinical perspective: conceptions of marital abuse, assessment of marital aggression and issues in treatment. Although there are specific cognitive-behavioural treatments reported in the literature, a position of caution is advocated here. Before intervening there are issues that the therapist should consider carefully. (1) Assessment must first answer whether conjoint marital therapy is appropriate at all. (2) Therapists must define their own position and estimate availability of supporting resources (e.g., legal, medical) when working with abuse. (3) Although all couples should be screened routinely for the nature and frequency of their aggressive patterns, neither the sensitivity nor specificity of currently available screens is yet established. Examples of current approaches to assessing spouse abuse are presented.

Cognitive theories and therapies of emotional dysfunctions are based on the premise that the affective, behavioural, and cognitive response repertoires are fused and highly interdependent. Such views have been criticised with the argument that affect and cognition are relatively independent and that there is a much more direct and stronger link between affect and behaviour. In an attempt to clarify potential differences in the interplay between affect, behaviour, and cognition in unipolar depression and phobic anxiety, a quantitative review of the relative efficacy of performance-based (behavioural) versus cognitive intervention for these disorders was conducted. The relative superiority of cognitive over performance-based interventions in the treatment of unipolar depression supports the notion of a reasonably direct link between cognition and affect for this disorder providing a fairly effective pathway for treatment. On the other hand, the relative success of performance-based techniques in the treatment of phobias suggests that for these disorders the link between behaviour and affect is more direct and much stronger than the link between cognition and affect. It is concluded that the relative effectiveness of cognitive and performance-based intervention techniques depends on and points to differences in the specific type of affect-behaviour-cognition interface that underlies and is controlling depression and phobic anxiety.

There is a well established relationship between marital discord and individual psychopathology in family members. This paper reviews evidence relating to patterns of marital interaction related to the co-occurrence of marital discord and three common psychological disorders: depression, alcohol abuse, and childhood conduct disorders. The effects of behavioural marital therapy (BMT) on dysfunctional marital interaction in such cases, and the impact of BMT on individuals' psychological disorders, are evaluated. It is concluded that BMT is often a useful component of treatment in each disorder reviewed. Further it is argued that it is important routinely to assess the relationship context in which these disorders occur. Finally, some of the difficulties and limitations of the application of BMT in cases where the presenting problem is an individual psychopathology are considered.

Four married couples were recruited from an outpatient alcohol counselling centre. Four husbands and one wife had recently received therapy for alcoholism and all but one was abstinent during the study. All scored as distressed on the Marital Adjustment Test. They participated in ten sessions of behavioural marital therapy emphasising positive reinforcement, communication, expression of feelings and problem solving. Problem solving discussions were audio-recorded at each session and analysed using a behaviour code. Measures of marital satisfaction, conflict and depression showed modest gains which were generally maintained at follow-up. Communication skills improved most with training, problem solving less so and feelings expression declined below baseline levels. These changes did not appear to be very durable. The non-abstinent client reduced his drinking to a level satisfactory to his wife during therapy. These findings support other recent work, draw attention to the need to find ways of promoting the maintenance and transfer of therapeutic changes and suggest that behavioural marital therapy may usefully be employed in outpatient alcohol counselling settings.