Fordyce's (1976) analysis of pain behaviour provides a framework for evaluating the extent to which empirical studies of the operant treatment of chronic pain have adhered to appropriate behaviour–analytic principles. These are the identification of target behaviours and their reinforcing contingencies, the specification of individualised reinforcers to be used in treatment, and the generalisation and maintenance of treatment effects. Twenty-five studies that reported having used an operant approach in the management of chronic pain problems were reviewed. With one exception, none of the studies reported sufficient data to indicate the degree of adherence to behaviour–analytic principles. Until more such data are reported, it will continue to be difficult to determine clearly those factors that contribute to the efficacy of operant approaches to chronic pain management.

Properties of “traditional service systems” are compared with properties that might be expected to produce “consumer-orientated” services. Identification of necessary goals and processes to change traditional services to consumer-orientated services is a complex activity. Blueprints for individual systems are not offered; however, an attempt has been made to identify general guidelines which may be of use to practitioners who wish to initiate change.

Miller's (1983) system of ‘motivational interviewing’ is elaborated by providing a theoretical context for understanding its impact, with a summary of research on motivational interventions. An extension of this approach, the Drinker's Check-up (DCU), is described as a potential intervention for health screening, treatment selection and matching, cleint self-assessment, and research. Initial data from a sample of 42 problem drinkers receiving the DCU suggest that this intervention may increase help-seeking and modestly suppress alcohol consumption. This approach is interpreted within the broader context of research on minimal interventions for problem drinkers.

It is accepted that for reasons of economy and efficacy the behavioural approach needs to be “given away” to those in day-to-day contact with clients. These new behaviourists may need special help if they are to use their skills to best advantage but can make a valuable contribution both to their clients and to practical knowledge in the area.

This paper investigates two contrasting family therapy approaches in the treatment of alcoholism. Twelve families were randomly assigned to either a symptom-focused or systems-focused treatment. Measures of marital satisfaction, family satisfaction and alcohol dependency were recorded before treatment commenced, after treatment and at a six-month follow up. The results showed that both treatments were equally effective in producing desired change, thus offering clinicians increased choice in the range of effective family interventions.

It has been argued that verbal reports and questionnaire data may be constrained by cultural and social demands to the extent that they are unlikely to show concordance with more direct measures of behavioural and physiological anxiety. The present report investigates this hypothesis with reference to social anxiety. It was found that physiological and cognitive questionnaires were good predictors of physiological anxiety and cognitions in a social interaction test. A behavioural questionnaire, however, was a poor predictor of actual behaviour. In the social interaction test, which was designed to produce anxiety, there was a high degree of concordance on all the measures except non-verbal behaviour and heart rate. Because behaviour ratings showed least concordance and the poorest predictive validity, it was suggested that a behavioural assessment alone may give an erroneous picture of a person's overall social anxiety.

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.

Recognition of and discrimination between seven Makaton symbols was taught to a young man with severe mental handicap and some physical difficulties which, combined with “poor motivation”, had previously resulted in his failing to learn signing. An errorless learning approach as well as tangible and social reinforcers were used to teach the symbols, while over-learning may also have been important in promoting retention. Following the successful completion of the programme the young man was accepted for speech therapy and further communication training, for which he had previously been thought unsuitable.

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.

If behaviour therapy is to remain viable and relevant, it needs to address key problems in the settings in which they arise. One major problem facing behaviour therapists is that of procuring institutional innovation. This study illustrates the successful application of an “organizational behaviour management” (OBM) approach within a psychiatric day hospital. The central issues of measuring and manipulating important system variables, and of relating these to clinical outcomes, are addressed by concurrent process and outcome evaluations with nurses and patients. It is concluded that OBM represents a promising and effective extension of the behaviour therapists' skills.

The generality of exposure effects in animal laboratory studies is reviewed. The validity of the animal model for exposure therapy is assessed using Bond's (1984) criteria. The specific criticisms of the animal model raised by Isaac Marks are responded to and discussed. It is concluded that the animal model for exposure therapy is substantially valid.

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.

A young man's serious sexual misbehaviour, which resulted in his being banned from his ATC, was tackled using a behavioural approach (reinforcement of appropriate behaviours) and counselling. This combined programme had an immediate effect in reducing his overt sexual activities at the Centre and promoting his acceptability there which has been maintained in the succeeding three years. The token system used helped not only to structure the young man's response but also, as concrete evidence of his success, to change attitudes towards him of Centre staff.

In a previous study (Felce, de Kock and Repp, 1986), appropriate client activity was found to be considerably higher in two community homes for severely and profoundly mentally handicapped adults than in a number of institutions. Client activity was also shown to be related to the extent of staff interaction. The method of this study was replicated in a two-year follow-up to investigate whether these desirable levels of staff interaction and client activity were maintained. Client engagement in appropriate activity remained similar for five subjects but had fallen slightly for a further five. The duration of instruction given to the majority of subjects by staff had declined but so too, for a variety of reasons, had staff–client ratios. Overall, the follow-up data give a general impression of the maintenance of client activity with some subjects engaging with greater independence. However, interpretation is dependent on the role that staff–client ratio may play in determining staff performance and in particular their level of interaction with clients.

Group training in anxiety management was compared with individual general practitioner appointments as a means of reducing dosage of benzodiazepines. Subjects were encouraged to withdraw at their own pace. Drug reduction, self-ratings of anxiety, depression and Health Locus of Control comprised the outcome measures. Process changes were recorded using visual analogue scales, and daily diary records. At the end of a six-week intervention period, the average dosage had significantly reduced in both groups. This reduction was maintined at a 15-week follow-up. There were no other differences in outcome between conditions. Although subjects reported a variety of symptoms during drug withdrawal, their occurrence was not significantly associated with the degree of dosage reduction.

Two opiate abusers and a solvent abuser were exposed to drug-related cues. Self-rated craving showed habituation within all sessions, although there was considerable variability between subjects in the time-course. Habituation between sessions also occurred, although this was less consistent. The level of craving was reduced in one case by a distraction procedure. Cognitive factors were investigated. For one subject anticipation of the stimulus led to high craving while for all three subjects drug-related imagery was associated with high levels of craving. Dysphoric mood states led to a re-emergence of craving (dishabituation) in two cases. One subject showed objective signs, and reported symptoms of opiate withdrawal during the exposure sessions. He had also shown needle-freak behaviour where the syringe and needle produced drugagonistic effects (pleasant, comfortable feelings or excitement). Implications of these results for the treatment of addiction are discussed.

A boy with mental handicap presented with problems of generalisation of toileting skills over a period of three years. From a variety of approaches attempted, one using transfer of stimulus control had initial success, and the process was completed using combined positive and negative reinforcement. Once generalisation to one novel setting had been achieved, generalisation to other novel settings proceeded without difficulty. There have been no further toileting problems in the four years since the completion of the programme.

A severe phobia of snakes was treated by exposure in imagination, no in vivo exposure taking place. Imaginal exposure homework was given with the aid of audio-tapes of the treatment sessions. After treatment, in a behavioural test, the client experienced rapid habituation of anxiety to handling a live snake. The total amount of time taken for the treatment was similar to the time taken in treating other small animal phobics by in vivo exposure alone. It is suggested that for specific phobics the use of imaginal rehearsal prior to in vivo exposure may optimise the conditions under which in vivo exposure takes places and require no more of the therapist's time than the usual in vivo methods.