Following a disputed review of a paper submitted to this journal the present paper seeks to raise the profile of some of the issues involved when the research community engages with vulnerable people. The paper is unashamedly polemical. It argues that this is a dangerous time for vulnerable people and that current protections are inadequate. The paper suggests the need to re-evaluate the whole relationship between the scientific community and vulnerable people but also tries to identify some practical and immediate improvements that could be made.

As we begin our second year published by Cambridge University Press, it is clear that this has been a tremendous development. The extra space has been put to good use, and feedback on the new format has been extremely positive. In 1999 we will work with the Press to develop parallel electronic/web based publication of the journal. More details of that soon.

Child sexual abuse is a prevalent form of child maltreatment that frequently occasions severe disturbance including posttraumatic stress disorder. This review focuses on recent cognitive-behavioural treatment initiatives designed specifically for sexually abused children, and the extent to which they are empirically supported. Our review draws on case studies, open clinical trials, multiple baseline investigations and randomized clinical trials. At first glance, the research findings are encouraging for the efficacy and acceptability of cognitive-behaviour therapy. However, more conservative conclusions are reached when stringent criteria are applied regarding evidentiary support for psychosocial interventions. Directions for future research are also explored.

Rosen, Lohr, McNally and Herbert’s (1998) arguments directed at the so-called “Power Therapies” and, in particular, Eye Movement Desensitization and Reprocessing (EMDR) are examined. It is suggested that their paper does not adequately review the available research data and, therefore, draws unwarranted conclusions. Based on published controlled studies it is concluded that there is evidence to support the use of EMDR in the treatment of post traumatic stress disorder (PTSD).

The study was a cross-sectional questionnaire survey of 29 women with a recent experience of coping with excessive drinking in a male partner. A number of cognitive and environmental factors were studied to determine the extent to which they predicted coping style and psychological well-being in this group. Results of multiple regression analysis indicated that “engaged” coping (characterized by attempts to change the drinker) was best predicted by a single cognitive variable (self-demands). In contrast, “tolerant” coping was best predicted by a combination of participant’s beliefs about their ability to withdraw from the drinker and the degree of drink-related hardship experienced within the family. “Withdrawal” coping, characterized by avoidant and independent behaviours by the women, was best predicted by a combination of beliefs about the necessity of withdrawal and the duration of time the participants had been coping with the excessive drinking. Finally, psychological well-being was best predicted by a single environmental variable (the degree of hardship caused by the drinking). A number of significant correlations were found to exist between the predictor and criterion variables and are discussed. Limitations of the study and clinical implications of the findings are examined.

There would be broad agreement with the need to address the issues put forward by Clements, Rapley and Cummins amongst service providers and researchers in learning disability. However, these authors' presentation of their arguments may well unnecessarily antagonize both groups. Additionally, it is suggested, the authors fail to identify the different paradigmatic bases of their proposals and thereby miss the opportunity to air genuine ethical dilemmas in learning disability research.

Post traumatic stress disorder (PTSD) and other reactions including driving phobias and depression have in recent years been clearly identified as common motor vehicle accident (MVA) sequelae. To date, no treatment outcome data exist for PTSD following MVA beyond case study reports and one pilot investigation. The present study reports on the first randomized control trial for PTSD following MVA. Twenty volunteer participants who had motor vehicle accidents resulting in physical injury requiring medical attention and PTSD were recruited through rehabilitation service providers, other psychologists, community physicians, and lawyers. Assessments included a structured interview for diagnosis of post traumatic stress disorder (Clinician Administered PTSD Scale) by an independent rater, a range of self-report symptom questionnaires and a behavioural test wherein they had their heart rate and subjective distress measured in reaction to idiosyncratic audio descriptions of their accident. Participants were randomly assigned to eight to ten hours of individual cognitive-behavioural therapy (n=10) or to a wait list control group (n=10). Treatment included education about post-trauma reactions, relaxation training, exposure therapy with cognitive restructuring and instruction for self-directed graduated behaviour practice. Results demonstrated statistically and clinically significant treatment effects across structured interviews, self-report questionnaires and the behavioural test. Treatment gains were maintained over a 6 month follow-up using self-report questionnaires.

This study explored whether obsessive-compulsive (OC) and depressive phenomena share common cognitive personality vulnerabilities. Specifically, the study examined the relationship of OC phenomena to sociotropy, autonomy and aspects of perfectionism, which traditionally have been associated with depression. A non-clinical sample of 152 subjects, mostly undergraduate university students, completed four questionnaires. Results indicated a significant relationship between depression and OC variables, with both relating significantly to autonomy, sociotropy and socially prescribed perfectionism. Correlations between OC phenomena and these cognitive personality styles were still significant after controlling for depression. Sociotropy and socially prescribed perfectionism predicted unique OC variance. Depression also predicted unique OC variance, controlling for the cognitive personality styles. It was concluded that OC and depressive phenomena share vulnerability centred on desires for approval. It was also recognized that depression-specific processes account for some of the covariability between depression and OC phenomena. Therefore, it was suggested that treatment of obsessive-compulsive disorder may improve by attending to the reduction of depressive phenomena and to the modification of beliefs related to social-approval.

We report a subgroup analysis of 24 out of 42 subjects who were hospitalized for non-psychotic major depressive disorder and who agreed to participate in interviews at admission and 2 years afterwards (as reported previously by Domken, Scott, & Kelly, 1994; Bothwell & Scott, 1997). At 2 year follow-up, these 24 subjects were categorized according to established criteria into clients meeting criteria for full remission (FR; n=9) and those meeting criteria for partial remission (PR; n=15). The most striking findings were that, over time, PR subjects showed significant loss of self-esteem and showed greater divergence in self-ratings compared to observer ratings of their depressive symptoms, whilst the same ratings in the FR group changed in the opposite direction. We suggest that the persistence of depression in PR subjects may provide evidence to support Teasdale’s (1988) hypothesis that some individuals “get depressed about being depressed”. The research and clinical implications of the results are noted.

Poole, de Jongh and Spector ask for empirical research rather than emotive arguments when evaluating EMDR. When one applies this standard, Poole et al.’s remaining points are devoid of substance. EMDR, like other Power Therapies, is a “miracle” cure that has failed.

In this response to the commentary on our original article (Clements, Rapley, & Cummins, 1999), we examine the rhetoric of the commentary as well as some of the substantive issues raised. Although there are areas of agreement we challenge some of the views put forward in the commentary, particularly those related to the institutional power of ‘‘science’’, the questions of accountability and the involvement of vulnerable people in research decision making. We argue strongly for action now to increase the checks and balances in the system and to promote more vigorously examples of good practice.

The debate conducted in this journal and elsewhere on the effectiveness of eye movement desensitization and reprocessing (EMDR) is characterized by incredulity, fervent belief and emotion. Theorists and clinical pragmatists, not to mention the “discovers” of EMDR, have often taken up oppositional stances that impede rationale debate. Whilst some may be offended by the overt commercialism and messianic fervour of the EMDR lobby, the best response is to engage in dialogue, collaboration and scientific experiment. These experiments should combine the best randomized clinical trial methods with experimental deconstruction of the complex mix that now comprises EMDR. Those who have developed EMDR should cease the commercial and empirical protectionism that has characterized the EMDR movement and open their methods to such investigation by the healthily sceptical.

Dementia is characterized by a decline in cognitive abilities that is sufficient to impair functioning in daily living. There are a number of forms of dementia (Alzheimer’s, vascular, Lewy body, etc), each with its own cognitive profile and developmental course. The present paper deals with the progressive dementias, such as Dementia of the Alzheimer Type (DAT). The cognitive deterioration associated with advanced DAT is often accompanied by a decline in emotional control, social behaviour and motivation. The paper focuses particularly on the emotional features of the disorder, because this issue has a profound impact on both the sufferer and carer. A framework for conceptualizing anxiety is presented, and a model of how this conceptualization can be used effectively within a carer’s training programme is discussed.

Traditional models of the relationship between cognition and emotion have typically presented the relationship between cognition and emotion as a single level of sequential processes. However, a number of more recent models have argued to the contrary that the relationship is complex and has to be modelled by multi-level processing systems. One such model, the SPAARS approach (Power & Dalgleish, 1997), is summarized, in particular, in relation to clinical theory and practice in the cognitive behaviour therapies. For example, the proposal in SPAARS that there are two parallel routes to the production of emotion has a number of interesting clinical consequences. Highlights are presented of what some of these consequences might be, and a number of recommendations are made for clinical practice.

The role of appraisal of negative events in social anxiety of adolescents was studied. One-hundred and sixty-eight Icelandic pupils between the ages of 13 and 15 years completed the Social Phobia and Anxiety Inventory for Children (SPAI-C), Children’s Depression Inventory (CDI), and measures of situational appraisal. Social anxiety was found to be specifically related to the appraisal as threatening of negative social events happening to the self. These relationships remained when depression was partialized out, whereas the reverse was not true. On the whole, the results support the notion of judgmental specificity in relation to social anxiety in adolescents.

This study compares the effectiveness of a standard cognitive-behavioural treatment for panic disorder with a reduced therapist contact program supported by self-help materials. This program shortens the total therapy length (from 10 to 5 weeks) and the contact time with the therapist (from 10 to 5 sessions). The sample was mostly referred from a public mental health unit, and it had a low level of education (average of 9.7 years). The subjects were assessed according to several variables related with panic disorder at pre- and post-test, and at 12-month follow-up. The results demonstrated that both programs produced significant improvements for all variables at post-test, the benefits were maintained at follow-up assessment, and even heightened for some of the measures. Also, both treatment programs obtained comparable improvements for most measures. These results suggest that the programs that reduce the contact with the therapist, supported by self-help materials, and shorten the time that the patient suffers from this problem (Margraf, Barlow, Clark, & Telch, 1993) may be a good intervention for the treatment of panic disorder. These programs can help to overcome some of the cost-benefit therapeutic limitations of standard cognitive-behavioural programs.

This study examined in detail the psychobiological correlates of panic attacks experienced in panic disorder with agoraphobia. The cognitions, affect, and physiology of the six patients were monitored during in vivo exposure to their phobic situations. The results from these case studies showed that catastrophic cognitions are the key component of panic attacks. However, there was no clear-cut evidence to support an interaction among cognitions, affect, and physiology, which has been postulated by cognitive theories to be the central component of panic attacks and panic disorder with agoraphobia.

A one year follow-up is reported of a randomized clinical trial with generalized anxiety disorder (GAD) in which the main comparison was between analytic psychotherapy (AP) and cognitive therapy (CT), each delivered at weekly or fortnightly intervals over a six month period. CT was found to be significantly more effective than AP. However, GAD is a chronic and relapsing condition and follow-up data are needed to assess the durability of improvement and the possibility that the benefits of analytic psychotherapy may be more apparent over the longer term. Data were collected in three areas: (1) symptomatology and overall improvement; (2) medication usage and contact with GPs; and (3) attitudes to therapy. CT was clearly superior to AP on the main outcome measures and only a minority of AP patients made significant improvements. CT but not AP was associated with significant reductions in medication usage, and patients receiving CT were generally more positive about treatment received. Differences between treatments were less evident in the less intensive treatment condition where overall results were relatively poor. The most positive outcomes were achieved in the more intensive CT condition in which approximately two-thirds of patients achieved clinically significant improvements.

Eczema is a skin condition with a multifaceted aetiology that includes both psychological and physiological components. A number of studies have indicated that cognitive-behavioural techniques (e.g. relaxation) are effective in the treatment of atopic eczema. However, it remains unclear from the literature whether different relaxation techniques have comparable treatment effects. The current study compared the efficacy of a single relaxation session with an imagery component with that of a comparable relaxation session without the imagery component. Eczema patients (n=9) who participated in relaxation with imagery reported significantly greater reductions in state anxiety and subjective ratings of itchiness and significantly greater increases in mental relaxation levels than eczema patients (n=9) who participated in relaxation without the imagery component. No group differences were found on changes in state anger. These results suggest that relaxation with an imagery component may be more effective than relaxation without an imagery component in lowering state anxiety levels and itchy sensations of atopic eczema patients.