A cognitive perspective of cognitive therapy training stress disorder (CTTSD) is presented. The authors present a cognitive model of CTTSD, preliminary data from randomized treatment trials, and discuss implications for effective treatment of CTTSD trainees.

Patients' beliefs about the causes of anxiety problems have received comparatively little attention. In the present study, agoraphobic patients rated the contribution of eight factors in causing their condition. They also selected the major cause of their agoraphobia and evaluated that in relation to the elements of attributional style. The most commonly selected major cause was stress, which also attracted the highest average ratings. This was followed in frequency by disposition (being a naturally nervous person), circumstances (staying home too much) and childhood experiences. Depression was associated with stronger beliefs in the contribution of several of the causal factors and with rating the major cause as more stable and global. Anxiety was associated with a stronger belief in medical illness as a cause, and with a lower sense of controllability of the major causes. These results suggest that agoraphobic patients' views of the causes of their condition vary, and could usefully be evaluated in relation to the provision of treatment in order to modify the way treatment options are presented to the patients.

Although body image problems are a major prognostic factor in the course of eating disorders, its treatment has received little attention in the research literature. We present two psychophysiologically controlled cases of intensive exposure treatment with conflicting outcomes. Pre-post treatment assessments included measurements of body size estimation, body related avoidant attitudes and body dissatisfaction. In case 1, although dissatisfaction and avoidant attitudes decreased, body size overestimation remained basically unchanged. Case 2 did not improve. Psychophysiological recordings showed a covert avoidance of treatment stimuli. We discuss the pros and the cons of the treatment, and the implications for the use of exposure therapy in body image disorders.

I have subtitled this address An Autobiographic View; it is also anecdotal and subjective. I find it fascinating to realize that my own autobiography coincides with, and indeed is part of, the history of behaviour therapy and, indeed, of much of clinical psychology as a profession in Britain. Clinical psychology scarcely existed before the Second World War. Even in 1945 the British Psychological Society listed it among terms not entirely meaningless, but too ambiguous for use by the Society. Between the Wars, there had been great resistance to lay encroachment upon medical territory, although there had been a little intellectual testing in mental hospitals by interested academic researchers. At the end of the war, Hans Eysenck came to the Maudsley having done his pioneer factor analytic work on dimensions of personality at Mill Hill. He was keen to establish a clinical psychology course, but was appalled by the existing main models along psychoanalytic lines, both in the United States of America and in the Tavistock Clinic in London. His most important initial recruit was Monte Shapiro, who became head of the clinical course of which I was an early student member and a relatively early staff member. The early emphasis was on assessment mainly by objective standardized tests. Indeed, much of our early intellectual effort went into disputations about the lack of validity of projective tests, such as the Rorschach. We had no real involvement in treatment. Aubrey Lewis, who was the Professor of Psychiatry at the Institute and the dominant figure at the Maudsley Hospital was very much against non-medical participation in therapy.

This paper is a description of one parent teaching group and what we and the parents did. The group was run by a psychologist and two social workers.

In Gwynedd a service for mentally handicapped people is developing. For most of the pre-school children and some of the older ones this includes a Portage type home visiting where usually a psychologist and a specialist community nurse or sometimes a social worker visit and help the parents to set goals and teach new behaviour to their handicapped relatives. Often, too, they are trying to help parents to cope with difficult behaviour.

A female irritable bowel syndrome sufferer was offered several strategies sequentially for coping with the complaint. Of these, bowel retraining established desired bowel frequency and exposure in fantasy resulted in decreased frequency and intensity of pain attacks. Both of these effects were maintained to 18-month follow-up.

Assessment and treatment of personality disorder (PD) is a key issue in UK mental health service provision (NIMH report, 2003), but there is limited information on individuals with personality disorder presenting to primary care mental health services. This study investigates the characteristics of PD in individuals receiving cognitive behaviour therapy (CBT) following GP referral and its relationship with therapist ratings of treatment process and outcome. One hundred and forty-eight participants completed the Millon Multiaxial Clinical Inventory (MCMI-III: Millon, Davis and Millon, 1997). Therapists completed a measure of therapy process and outcome (TPOQ) on 100 participants. Key therapy and process questions were answered for 60 participants who attended a minimum of five therapy sessions. MCMI-III indicated a rate of PD of 56.4%. Factor analysis of PD scales identified two factors: inward looking/emotionally distanced, and aggressive/acting out. For clinical syndromes (CLS), the factors were general psychopathology and substance abuse. TPOQ had two factors: therapeutic alliance and complexity in therapy. Regression analyses indicated that only those PDs contributing to the inward looking/emotionally distanced scale score were associated with therapeutic alliance problems. Conversely, complexity in therapy was only predicted by general psychopathology and not by personality disorder. This study identified high rates of personality disorder in primary care referrals to a clinical psychology service. It also indicated that relationships between the presence of personality disorder and therapist ratings of treatment difficulties were only associated with certain types of personality disorder. These findings are discussed in relation to service and therapy planning in mental health.

Two experiments investigated the effects on persistence of behaviour in extinction of different training procedures, using mentally handicapped boys who were trained to place objects of different shapes into matching holes in a box for sensory reinforcers. In Experiment 1 two subjects were given three training procedures: (i) a C-C procedure, consisting of 80 trials of continuous reinforcement (CRF); (ii)a P-P procedure, consisting of 80 trials of variable ratio reinforcement (VR5); and (iii) a C-P procedure, consisting of 40 trials on CRF followed by 40 on VR5. Extinction occurred most quickly after C-C training, next quickest after P-P training. In experiment 2 with four boys, C-P training of 160 trials of CRF, followed by 120 trials of VR5, produced quicker extinction than P-P training of 280 trials of VR5 reinforcement. The implications of these results for training persistent behaviour in mentally handicapped people 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.

Previous reports of the effectiveness of behavioural approaches in the treatment of blepharospasm prompted application of a modified behavioural package to two hemifacial spasm patients. The presentation and treatment details of these two cases are described with complete remission of symptoms in one patient and 50% reduction in severity for the second patient. Both hemifacial spasm and blepharospasm are traditionally unresponsive to medication and are treated by a variety of neurosurgical techniques, thus implying a strong organic etiology for the conditions. The cases presented here, and earlier cases presented elsewhere suggest that a learning model may be appropriate to explain etiology for an unknown number of patients who are surgically treated at present. This is discussed in the light of existing literature on the conditions along with methodological and theoretical issues.

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.

On a cold and dull Autumn Friday in 1972, I was among hordes of Behaviour Changers/Modifiers/Engineers/Therapists (all to become Psychotherapists) making their way from the four corners of Britain to the Middlesex Hospital in London. We were all going to a meeting to discuss the setting up of a National Association for those interested in Behavioural … whatever. When I arrived, I was refused entry unless I paid £3 annual membership fee to the very smartly dressed bouncer on the door who claimed to be the Treasurer. “But I thought the meeting was to decide if we are going to form an Association and, if so, to elect the officers!” My protests were in vain, as would have been my 460 mile day trip if I had not parted with my £3 — I have never really mastered contingency management!

The successful treatment of faeces retention in a 6-year-old boy is discussed in the light of recent findings in the literature which suggest the need to take both family and therapist variables into account when training parents in child management skills. Details are given of the family variables considered relevant to the presenting problem in this case: lack of paternal motivation to co-operate in treatment, maternal depression and social isolation, and problem behaviour in a sibling. The treatment plan designed to take account of these variables is described, as well as the problems (and their resolution) encountered in implementing it. Successful outcome was maintained at three and six month follow-up. It is argued that wider use of this model of an expanded case study would provide useful hypotheses for future research, as well as clinical relevance for other practitioners.