The need to monitor the standards of care provided in settings for the long term psychiatrically disabled has become increasingly recognized. A critical review of the literature indicated that no comprehensive assessment procedure existed for settings providing some form of rehabilitation. However, five important aspects of care in each setting were identified: (i) Treatment Practices, (ii) Unit Management Practices, (iii) Community Contact Practices, (iv) The Physical Environment and (v) Staffing Resources.

A series of questionnaires was devised—The Model Standards Questionnaires—to assess each of these aspects of care. The questionnaires can be used to provide a profile of particular settings quality of rehabilitation and as a means of identifying how the quality of that rehabilitation might be improved.

The majority of investigations in the literature have concluded that body image is a relatively fixed phenomenon, the juvenile onset of obesity often being associated with a body image distortion which is presumed to be especially impervious to change (Stunkard and Burt, 1967; Hirsch, 1972). Nevertheless, the evidence for this suggestion is not conclusive (Collins et al., 1983), and is challenged by the findings of the present study. When subjected to regular videofeedback over a period of approximately four months, one group of obese subjects successfully lost weight, and appeared to improve the accuracy of their body image estimates. Another group of obese subjects who underwent a behaviour modification programme over the same period also lost weight and showed a lessening of body image distortion at the end of this intervention, but the changes observed between assessments were much greater for the video group. Some individuals in both treatment conditions had experienced juvenile-onset obesity. The fact that those who received videofeedback also showed improvement in terms of body image assessment and weight loss lends added support to the suggestion that the experience of videofeedback is therapeutic for the obese.

This paper describes two cases involving the use of cognitive behavioural therapy (CBT) to treat the positive symptoms of schizophrenia. In both cases the individuals were experiencing acute psychotic symptoms during their first admission to hospital. Each case illustrates how CBT was used to tackle a particular issue pertinent to the delivery of treatment at this early stage in the development of an individual's experiences of psychotic symptoms. Case one describes therapy with a young person of 17 where developmental issues are pertinent; case two describes the use of therapy to engage a person whose symptoms have ostensibly remitted. In both cases the promotion of understanding of the origin of their experiences was vital to the conduct of therapy. The implications of these issues to conducting therapy with this client group and the methods used to overcome them are discussed with reference to the future developments of cognitive behavioural therapy for use with this client group.

The study examined the effect of guided imagery on overt social behavior of children during free play. Forty withdrawn and rejected first-graders (6 to 8 years of age) were randomly assigned to one of five conditions. Four of them were guided imagery conditions: mastery plus peer acceptance, mastery with no social contingency, coping, and gradual rehearsal. A fifth control condition involved no intervention. It was predicted that the four imagery conditions would increase and maintain positive socialization, but the coping condition would be the most effective. Children under the coping condition, which involved guided imagery of failure to get peer acceptance, but progressively mastering the social interaction and finally being accepted by peers, consistently increased positive socialization behaviors from baseline to post-treatment and follow-up, as compared to gradual rehearsal and control. Both mastery conditions increased socialization at post-treatment, but reverted to baseline levels during follow-up.

The patient was an 18-year-old girl with a 2-year history of incapacitating Obsessive–compulsive avoidance behaviour for a severe germ phobia. Previous in-patient admissions had failed to produce any improvement. There were no staff in the hospital where she was admitted with any expertise in behaviour therapy so the author was called in as an outside consultant to advise on possible treatment.

A full assessment was made of the patient and the basic behavioural ideas of “modelling”, “flooding” and “avoidance behaviours” were introduced to the entire ward staff. It was decided to employ the ward sisters as the main therapists who were to act as “models”. Target behaviours for change were selected with the patient and baselines obtained before active treatment commenced. Target behaviours were handwashing, time spent in toilet, amount of toilet paper used, rituals before, during, and after showering. In addition, a “germ contamination” hierarchy was constructed. By the 18th week of in-patient treatment, all target behaviours, except going to the toilet to defecate, were under control. This latter behaviour eventually responded well several months later when she was no longer an in-patient. At 2-year follow-up, this girl was entirely free of all “germ” phobias and the associated obsessional avoidance and decontamination rituals.

Background: Behavioural activation (BA) is an effective front-line treatment for depression but some consumers find it unattractive or aversive, and its rationale unconvincing. Aims: To investigate whether individual differences in symptoms of depression, borderline personality pathology or adverse childhood events would: (1) influence ratings of BA treatment credibility; (2) predict credibility rating differences in comparison to schema therapy (ST) exemplifying a contrasting theoretical rationale with a significant developmental history focus; (3) a third aim was to test whether BA credibility was increased by providing research evidence of its efficacy. Method: In an online within-subjects experiment, 219 Australian community adults completed the Credibility/Expectancy Questionnaire following written descriptions of BA and ST (presentation order randomized across participants), and again for BA after receiving information about research supporting BA's efficacy. Results: Higher childhood adversity (but not severity of depression or borderline personality disorder symptoms) predicted lower BA credibility. Overall, ST was rated more credible than BA, but presenting BA evidence increased BA credibility ratings to match ST. This response was moderated by individual differences: participants with higher childhood adversity or previous therapy experience found ST more credible than BA even after receiving BA evidence. Conclusions: Individuals are not equally receptive to BA. Presenting research evidence is an effective strategy for increasing credibility, but additional intervention or tailoring the rationale is recommended for clients with significant childhood adversity.

Background: Few studies have examined the acceptability and usefulness of enhanced cognitive behavioural therapy (CBT-E) for adolescents with eating disorders (EDs). Aim: To investigate whether CBT-E was an acceptable and efficacious treatment for an adolescent presenting to a routine clinical service with an ED. Method: Daily self-monitoring records were completed during a baseline (A) and intervention (B) phase in addition to routine outcome measures. Results: There were reductions in both ED behaviours and “feeling fat”, and increases in weight after 11 CBT-E sessions. Progress was only partially maintained at 8-month follow-up. Conclusion: CBT-E may be an acceptable and useful intervention for adolescents with EDs.

The progressive development of vocal responses in a 72-year-old male schizophrenic patient with a history of 48 years of complete mutism is described. The emergence of recognizable words and phrases is closely linked to the application of a range of behaviour modification procedures. The programming of generalization of treatment effects across individuals and across settings is also described.

Various investigations into the relative effectiveness of different treatment procedures with agoraphobic patients (e.g. Emmelkamp, 1974; Emmelkamp and Wessels, 1975) have shown that in-vivo exposure is a common factor in successful aproaches. Emmelkamp (1974) has suggested that in-vivo exposure is the essential element of treatment which may eventually result in habituation. He has also demonstrated (Emmelkamp and Emmelkamp-Benner 1975) that group treatment can be just as effective as the same approach used individually, which has obvious implications for cost-efficiency.

I remember quite well my first exposure to an international conference of behaviour therapists, albeit through a haze of Irish hospitality. As a trainee clinical psychologist in the early 1970s, at a time when training budgets could stretch to the occasional foreign conference, I was fortunate enough to attend one of the early, and now infamous, Wexford Congresses on Behaviour Modification, organized by the now defunct Behavioural Engineering Association of Ireland.

Two reviews have recently appeared which are relevant to the continuing debate on the effectiveness of the ‘cognitive therapies’ (Ledwidge 1978; Di Giuseppe and Miller 1977). Their conclusions differ in emphasis, Ledwidge's position being exemplified by the title of his article, “Cognitive Behaviour Modification: A Step in the wrong direction?”, while Di Giuseppe and Miller conclude “the results (of Rational Emotive Therapy) are positive and hopeful … (but) far from conclusive” (p.91). It will be argued that the authors show some selectivity in the data they consider relevant to this topic, and that their conclusions are, in part, related to such selectivity.

A DRO approach was used to teach positive social behaviours in a young woman with mental handicap, and to decrease aggressive and disruptive behaviours. Reprimands were used on a few occasions for serious problem behaviours and did not result in an increase in these behaviours. As the problem behaviours receded the young woman became apparently happier and developed better relationships with her family, peers and Centre staff, and the improvement has been maintained over three years.

The procedure of cue-exposure response prevention has been successful in reducing subjective urges and overt behaviour associated with a number of compulsive disorders. Despite this it has not been systematically applied to the problem of smoking cessation. An individual case is presented which demonstrates the successful decrement of urges to smoke as a result of cue-exposure response prevention. The relevance of such a procedure to relapse prevention is discussed.

Considerable concern has been expressed about the quality of care provided for mentally handicapped children living in hospitals. Current policies aim to relocate these children in community settings, giving them a lifestyle as near as possible to that in an ordinary home. Studies of mentally handicapped children living in hospital have all shown that the quality of care is poor, but comparative studies of the quality of care provided for mentally handicapped children living at home have not been carried out. This paper reports a comparative observational study of the quality of care provided for profoundly mentally handicapped children living in a long-stay hospital with a match group who live at home. The rate and content of naturally occurring interaction patterns between nursing staff or family members and the children were observed during the hour after arrival home from school. The results show major differences between the two settings in terms of the types of behaviour exhibited by the children, the frequency and nature of attention given to the children and the quality of the interactions between the children and their carers. In all areas the children living at home fair better. The implications of these findings are discussed.

Several empirical studies suggest that exposure in vivo and response prevention have a differential treatment effect on the complaints presented by patients with Obsessive-Compulsive Disorder (OCD). In the present study it was hypothesized that exposure in vivo would result in a greater decrease of obsessional fear, whereas response prevention would result in a greater decrease of rituals. Forty patients, diagnosed with OCD, participated in the study. Half of the patients received exposure in vivo alone, followed by response prevention alone, and half received response prevention alone, followed by exposure in vivo alone. No differential treatment effects between exposure in vivo alone and response prevention alone could be found, although ritualistic behaviour was less strongly affected by exposure in vivo following response prevention.