It is fitting that the first mini-series issue of Behaviour Change should be devoted to an exposition of current cognitive-behavioural treatments for various aspects of schizophrenia. The disorder has a surprisingly high incidence in the population. Approximately 1 in 100 people will develop schizophrenia during the course of their life-time (Cancro, 1980). Arieti (1981) observes that more hospital beds are occupied by individuals suffering from schizophrenia than from any other psychiatric or medical problem, including cancer or cardiovascular disease.

The introduction of the phenothiazines in the 1950s resulted in dramatic increases in hospital discharges for schizophrenic patients but did little to change the “revolving-door” phenomenon. This chronic relapsing population is characterized as “the patient's having been admitted to an inpatient mental health facility several times and/or having been hospitalized for a period of at least a year on a single admission,” as well as possessing “a number of deficits in adaptive behavior” (Matson, 1980, p. 169). Indeed, whilst the schizophrenic individual's most florid symptoms e.g. delusions, hallucinations and thought disorder, may be well controlled on even minimal dosages of the neuroleptics (generally leading to that person's discharge from hospital), other social and self-care deficits may remain prominent reminders of the patient's difficulties in everyday living.

The chronic schizophrenic patient's deficits are characterized by an ambivalent relationship with the outside world. On the one hand he displays a lack of willingness or ability to interact appropriately with other people, and on the other hand, he depends on significant others such as a parent, other relative, or even a health professional. Despite this, he has a poor social network. He has reduced expectations of himself, is unable to effectively problem-solve, and his lifestyle reflects a desire to have an uneventful existence, free from harrassment. He becomes alienated from society, and may be unable to seek and gain employment, live independently, or manage routine responsibilities, e.g. financial budgeting.

External variables and measurable aspects of human behaviour, biology, mind, emotions, and whatever else one cares to name are all that psychologists and other professionals concerned with behaviour change have to respond to and manipulate. A two factor model thus is proposed to maintain attention and action on goals and methods. In the course of arguing this position, some common misconceptions of the operant model are corrected.

A crucial aspect of behavioural assessment and intervention is the initial interview with the client. Although the interview is the most frequently employed method of assessment, very few published behavioural interview schedules are available to clinicians. The authors present an interview schedule for the behavioural assessment of children's problems. Hopefully, such devices will improve the reliability and validity of problem identification and facilitate effective case management.

An overview of schizophrenia is presented. The epidemiology and clinical features of this common but serious psychiatric disorder are outlined. Four case vignettes illustrate different presentations and, to some extent, the varying course of the disorder. Diagnostic issues are discussed and the heterogeneity of the disorder highlighted. The major aetiological hypotheses are outlined, including evidence for genetic and biochemical involvement, the role of family, social and personality factors, psychological mechanisms and life events. A diathesis-stress view is presented, in which biological vulnerability and psychological and environmental factors are necessary for the development of the clinical disorder. Somatic and psychosocial treatments are briefly discussed as are the course, possible outcomes and factors affecting prognosis. Finally some future research directions in both the biological and psychosocial areas are considered.

Deficiencies in social skills are a major problem in the rehabilitation of schizophrenic patients. To adapt to community life, schizophrenic patients must meet certain minimum levels of socially acceptable behaviour. Over the last two decades, social skills training procedures have been used to systematically teach these behaviours. Procedures typically used in social skills training include instructions/coaching, modelling, behavioural rehearsal and role play, feedback and reinforcement, and homework assignments. These and other procedures are discussed in this review. In addition, the outcome of social skills training for the schizophrenic patient is discussed with reference to short- and long-term changes in social behaviour.

The alternating treatments design which is increasingly being used in single subject research is described. This design allows the differential effectiveness of two or more treatments to be investigated by presenting each of them separately in closely spaced sessions, with the order of presentation alternated. Consideration is given to the types of behavior and contexts that are most appropriate for use with this design and also to factors important for ensuring its effectiveness and the valid interpretation of the resulting data.

A change has taken place in the role ascribed families in the treatment of schizophrenia. Rather than being implicated etiologically, families are seen more as the natural support system in preventing relapse of schizophrenic illness after discharge from hospital. The factors predicting relapse are reviewed including expressed emotion, communication deviance and medication compliance. From these, a set of objectives for treatment have been derived and the behavioural family intervention programme of Falloon and Liberman is described. Outcome research on the efficacy of this and the psychoeducational family approaches show short term benefits in relapse prevention and symptom amelioration but that more long term follow up data are needed. Further research also needs to address the relationship between outcome, specific treatment modality, medication use and the behavioural disturbance of the patient.

The development of an in-service teacher training package is described which has the aim of training primary and middle school teachers to use behavioural methods of classroom management. It is shown how the package evolved from the programme of experimental behavioural research carried out by the authors in schools over the last ten years. Emphasis is placed on the on-going evaluations of successive versions of the package. The package was continually revised until it could meet the criterion of bringing about measurable changes in observed teacher behaviour and in the behaviour of primary and middle school classes. Experimental findings supporting its effectiveness are presented and discussed.

This paper addresses organisational issues associated with the effective use of Batpack, an in-service training program described by Wheldall and Merrett as aimed at training practising teachers in a number of key behavioural skills. It is argued that the key to developing training programs which have long-term maintenance of training effects is to have organisational environments which support appropriate work behaviours of teachers. This means that a careful consideration of the antecedents and consequences associated with the daily work activities of all organisational members must be carried out to ensure that training gains will not be extinguished or punished by organisational policy and practices.

Developments over the last twenty years in the use of token economies in psychiatric institutions are reviewed. Token economies are considered in the context of two systems: the internal social system of psychiatric institutions and the mental health service system as a whole. Two themes emerge: the first concerns difficulties in establishing and maintaining token economies and the second, the impact of deinstitutionalization policies. It is argued that, although token economies remain viable for intervention goals internal to the institution, they have not been proven viable in furthering the goals of deinstitutionalization. Post-institutional programmes and community alternatives to institutions are of more current value than token economies in institutions.

Behavioural marital therapy (BMT) is a promising approach to the pervasive concern of lack of marital satisfaction. BMT produces gains in marital satisfaction which are statistically significantly superior to no treatment controls. However when more stringent criteria for success are applied, which are of greater clinical relevance, success rates are moderate. It is argued the limitations of BMT efficacy may be due to three faults in the current conceptualization and practice of BMT. Firstly, while some recognition of the role of cognitions has been made, the salient cognitions of distressed couples have not been clearly described in specific social contexts. Secondly, the cognitive interventions used do not relate clearly to identified maladaptive cognitions. Finally, the generalization of therapeutic effects has been assessed insufficiently, and generalization has not been programmed into therapeutic procedures. Specific suggestions are offered which may help to help overcome these problems.

Trends in behaviour therapy are considered from the advent of cognitive behaviour modification to the more recently suggested emphases on affective and unconscious processes. The thrust towards integrating different schools of psychotherapy is also briefly reviewed. The gains and losses associated with the trends are discussed. Some suggestions for the future are offered with respect to potentially profitable directions for behaviourally orientated researchers, practitioners and teachers to follow. A general theme of the paper is that behaviour therapy appears to be fractionating at an accelerating rate, and whilst this carries the potential for some very significant advances, it also carries the potential for destroying the unique contribution of the behavioural approach.

Biofeedback procedures for stress reduction have been widely used in a variety of settings. While there are many reports of the successful application of EMG procedures for general tension-reduction with adults and children, little has been done concerning these procedures with children who suffer from a specific learning disability. The present paper reviews the use of EMG biofeedback with learning-disabled children and, after examining those studies performed to date concludes that the supportive conclusions drawn by previous authors can be criticised on methodological grounds, and that the issue of indirect treatment of learning disability via EMG biofeedback is open to discussion. Directions for future research are described.

The investigators explored whether electromyographic (EMG) mediated biofeedback would help patients with cervico-brachial pain syndrome (CBPS) reduce muscle contraction and aid in pain relief. Twenty seven volunteer subjects with medically diagnosed CBPS were randomly assigned to two groups. The experimental group received EMG biofeedback mediated muscle relaxation of the neck for five, 40 minute sessions. The participants in the other group acted as "wait list" controls, and in turn, received treatment at the end of the study. Pre and post intervention measures consisted of EMG recordings of neck muscle activity; self-report measures of neck and general body relaxation, level of pain intensity, depression, anxiety and functional impairment. The results indicated that neck muscle activity, as measured by EMG, was significantly lower at the end of training. Associated with this reduction were a significant increase in self-reported neck and body relaxation and a significant reduction in the average intensity level of pain experienced by subjects over the pre to post intervention period. No changes were reported for the other measures.

This study investigated the effectiveness of reinforcement procedures in retraining upper extremity movement impaired as a result of cerebrovascular accident. A simply constructed instrument permitted accurate measurement of motor responding and, under some treatment conditions, provided the subject with direct feedback of movement. Experimenter praise for movement which met a pre-selected standard or criterion, in combination with binary visual feedback of performance and a knowledge of progress condition, was shown to bring about continuing improvement in the hemiplegic subject's range of supination. Praise with binary feedback alone functioned only to sustain responding at above baseline levels.

Many parents experience considerable difficulty in getting their children ready for school or kindergarten in the morning. The “Beat the Buzzer” procedure described by Drabman and Creed on (1979) has been used extensively by clinicians to eliminate morning confrontations between parents and their children. The steps to be followed in the use of the procedure are outlined, and two case studies illustrating modification to the basic procedure are presented. Finally, discussion is given to issues that need to be considered when using the procedure and suggestions for further research evaluations are made.

A case study is presented of a young woman with an unusual phobia, a fear of babies. Barabasz's (1977) technique of systematic desensitization using psycho-physiological measures was chosen as the main treatment strategy. Difficulties arose as the client was unable to visualise scenes involving babies. Nor could she look at photographs of babies long enough for the hierarchy to be ordered using a psycho-physiological measure (skin conductance). A set of photographs was eventually used for the hierarchy, but it was ordered in terms of the length of time the client could look at the various photographs. Systematic desensitization was carried out using the set of photographs instead of imaginary scenes, together with some in vivo exposure in the latter stages of treatment. At termination the client could approach babies without discomfort. Improvement was maintained at one year follow-up.

Mild punishment, overcorrection and reinforcement of an alternative behaviour were used to reduce and eliminate the incidence of severe self-injurious behaviour in an autistic 12-year-old boy who had sustained major damage to his wrists and fingers. Data were collected over 10 × 30-minute periods per day and showed that banging and touching of a protective cast and later the injured hand itself were reduced to zero in approximately three weeks. The injury had healed and self-injurious behaviour was still extinguished at 10-month follow-up.

An extensive review of the various approaches to therapy has found that most, if not all, can be described by epithets normally attributed to behaviour therapy, such as arid, rigid and sterile. Little-known papers have shed light on what could be described as existential leaps, or paradigmatic shifts in approaching therapy, leading to the present paper. This paper describes an entirely new approach to therapy, known as Hat Therapy, which embodies a collection of techniques thread through with a unifying theory. The origins, and empirical data supporting the theory behind Hat Therapy are presented, along with an explanation of new terms necessarily coined to encompass the complexity and originality of the approach. Applications for behaviour change are also presented.

In an earlier contribution to Behaviour Change, a five-factor framework which recognizes both environmental and internal mediating determinants of behaviour was presented (Molloy, 1984). The five factors constitute a dynamic interdependent system whereby a change in any one of the components affects one or more of the other elements. The model is intended as an heuristic device for formulating and testing hypotheses and to illustrate how human behaviour, beyond simple habits and reactions, is multiply determined.