1978 was marked by the publication of two major reports on gambling, the Royal Commissioners Report (1978) and the Home Office Research Report by Cornish (1978). These are in many senses complementary publications. The Royal Commission presents a wealth of factual data on the various forms of gambling in the UK, and devotes only two pages to the psychology of gambling, in which reference is made to Cornish's report and endorsement given to the conclusion. Cornish offers an extensive and systematic review of psychological and sociological approaches to gambling with an interesting synthesis and suggestions for future research. The present paper is in no way attempting to parallel Cornish's exhaustive treatment of the subject, but rather to argue for and examine a specific approach to the problem of gambling.

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.

I'm going to describe the unitary approach, a recent model for social work, and then use the model to pinpoint the place of behavioural procedures.

Social Work is — or aspires to be — a profession that carries out a planned change process aimed at helping people who are having difficulty with life tasks. These tasks range from coping emotionally and practically with the birth of a handicapped child, to keeping within the rules of society, to obtaining the basic supplies: food, shelter and satisfying personal relationships, and they require emotional, cognitive and material resources.

In recent years, a growing body of research has established that children who have poor peer relationships are particularly at risk for the development of later psychiatric and antisocial disorders — for instance, they are more likely to drop out of school, be later identified as juvenile delinquents, and have mental health problems in adult life (Asher et al., 1977). Children who are picked out by their peers as isolated or rejected are particularly vulnerable (Cowen et al., 1973; Roff et al., 1972). This finding has led researchers to evaluate “popularity” by sociometric tests which involve asking children who their friends are and who they dislike. Such sociometric scores have been shown to have moderate reliability (Roff et al., 1972), but much depends on the type of question asked (Oden & Asher, 1977). In particular, it is clear that sociometric acceptance has different correlates from sociometric rejection, the former being more an index of amount of social participation (Combs & Slaby, 1977), the latter of its quality.

Since obesity is a persuasive health problem in our society one would expect that treatment outcome evaluation of weight control methods has received a great deal of attention. Unfortunately, nothing could be further from the truth. Weight control fads reach heights of widespread popularity despite the absence of extensive clinical evaluation. Follow-up evaluations that have been reported tend to be extremely brief. For example, the vast majority of behavior modification studies of obesity have reported follow-up data for only 6 to 8 weeks (Brownell, in press). In fact, in a recent report, Gotestam (1979) found only three behavior modification studies of obesity with a follow-up of one year or longer. This is a particularly crucial problem due to the high proportion of relapse observed during the first year after obesity treatment.

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.

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.

Two previous articles report the successful treatment of chronic blushing (Salter, 1952, Case 10; Gibbs, 1965). Both cases employed techniques which were designed to increase the patient's self-assertiveness. As an adjunct to his therapy, Salter instructed his patient in the use of paradoxical intention to diminish blushing behaviour. This technique derives from Dunlap's (1932) beta hypothesis on learning which states that “the occurence of a response lessens the probability that on the recurrence of the same stimulus pattern, the same response will recur” (page 78). The present case describes the treatment of blushing with paradoxical intention alone.

The story of the creation of the cognitive trend in behaviour modification, cognitive behaviour modification (CBM), might well, if ever written, begin as follows:

In the beginning Skinner created behaviourism. Behaviourism, in its radical form, was pure, elementary, objective, and visible to all. So, when Skinner observed everything he had created, he said: “Let behaviourism bring forth operant man to study and manipulate S and R in mice, pigeons, rats, and men”. It was in the forties and it was the fifties; the first period. Now, when Skinner saw operant man, surrounded by light, sound, and food, throwing pellets to the pigeons and studying the behaviours of mice, rats, and men, Skinner said: “Thou, operant man, are permitted to touch every branch of the radical trees in my paradise of freedom and dignity, but … the tree of knowledge and cognition thou shalt not touch lest thou be seduced”. Operant man, however, was cunning and sly, and said to himself: ‘On the day I will touch the tree of knowledge and cognition, I shall surely unravel the secret behind S & R; then I shall be like Skinner, master of prediction and explanation”. So operant man acted upon his internal dialogue and not only touched but actually ate from the forbidden fruit. When Skinner saw that operant man had transgressed his comandment, his anger was kindled. He then said to operant man: “Since thou hast tasted from the forbidden fruit, thou must leave this pure garden. I hereby condemn you to descend into the valley of mentalism, where thou shalt wander and wonder for ever and ever, since the causal path knows no end. Further, from now on thy name is not operant man anymore, but coverant man”. Now this is the history of coverant man …

Research in cognitive-behaviour modification (CBM; Meichenbaum, 1978) continues apace, and a particularly important area is the study of the “crucial ingredients” of successful CBM programmes. However, findings reported to date are not unequivocal. For example, in a recent article, Glogower, Fremouw and McCroskey (1978) report that the rehearsal of coping self-statements was a more effective component of cognitive restructuring than imparting insight into unhelpful self-statements in reducing performance anxiety about speaking in a group. A treatment condition which combined both procedures was most successful in general, but was not significantly better than rehearsal alone. The study was well-designed and implemented, and the authors were able to support their conclusions by referring to both self-report and behavioural data. The results directly contrast with those of Thorpe, Amatu, Blakey and Burns (1976), who sought to test similar hypothesis in a similar experiment in Britain. Glogower et al. correctly point out the differences between the studies include the relative youth of subjects, brevity of treatment, and few kinds of coping self-statement used in the Thorpe et al. study. They further indicate that a combination group has fared well in studies other than their own (e.g. Fremouw & Zitter, 1978), but that in the Thorpe et al. study the combination procedure, similar to the instructional rehearsal procedure, was significantly less effective than “insight” on self-report measures.

The integration of cognitive processes and behaviour change methods, generically known as cognitive-behaviour modification, has sparked off a series of heated arguments about the status of this hybrid (Greenspoon and Lamal, 1978; Ledwidge, 1978; 1979 (a); (b); Mahoney, 1974; 1977; Mahoney and Kazdin 1979; Meichenbaum 1977; 1979; Rachlin, 1977(a); (b); Wolpe, 1976; 1978). At the considerable risk of adding fuel to an already inflamed debate, I have drawn up a list of myths which the opposition to cognitive-behaviour modification has promulgated. Myths are, of course, a potent source of influence, and I am not at all sanguine that labelling the lines of opposition to cognitive-behaviour modification as ‘myths’ will change peoples' cognitions or behaviour. Nevertheless, in the interests of academic debate, and indeed in the pursuit of truth,* I have listed what seem to me to be the essential fallacies in the arguments against the cognitive-behavioural movement.