The growing “family” of cognitive-behavioural interventions has made impressive strides in the management of schizophrenia over the last decade. This paper critically reviews the advances that have been made and examines some of the controversies and difficulties encountered in the application of this approach and suggests areas for future growth and research. Future developments in family interventions, early intervention, the management of hallucinations and the potential utility of a form of psychotherapy to treat secondary depression and prevent suicide, are covered in depth. Service structures to integrate these interventions, their timing and duration are considered. It is suggested that the marriage of case management and psychosocial interventions in particular is now overdue.

One hundred and nine patients with a primary diagnosis of GAD were allocated to either cognitive, behavioural, cognitive-behavioural or placebo versions of “Stress Control” large group didactic therapy or to a waiting list condition. Each group was run by two therapists and, with the exception of the placebo, contained between 20 and 24 patients. A wide range of measures were administered at pre-, mid- and post-therapy and at six month follow-up. At post-therapy, all therapy conditions showed highly significant change on almost all measures, with the active therapies, and to a slightly lesser degree, the placebo, being significantly different to the waiting list on most measures. At follow-up, the active treatment conditions enhanced post-therapy improvements, while the placebo condition maintained progress. No significant differences existed between the four treatment conditions at post-therapy and, with the exception of one measure, at follow-up. However, a trend at both points favours the cognitive and behavioural conditions.

Recent developments in the understanding, assessment and treatment of suicidal behaviour are reviewed. The accumulated social and demographic knowledge of suicidal populations has proved to be clinically useful in shaping the general level of concern, but at the individual level an understanding of the psychological processes involved in suicidal behaviour is required. Studies examining psychological processes involved in suicidal behaviour is required. Studies examining psychological processes in parasuicidal groups have revealed a number of deficits, including poor interpersonal problem solving, hopelessness about the future, and reduced ability to regulate affect. Research has also begun to look at some of the processes underlying these deficits, such as over-general retrieval of autobiographical memories and reduced anticipation of specific positive experiences. The clinical picture is now more optimistic, with therapies, such as Dialectical Behaviour Therapy, which focus on using problem solving strategies with those clients who are most vulnerable to repeat parasuicide episodes, producing demonstrable delays in parasuicide and reduced risk of repetition. The importance of the relationship between research and clinical practice is emphasized.

Self-injurious behaviour in people with learning difficulties has been found to be a common and health-threatening problem. As a consequence, there is an expanding literature addressing a variety of methods of intervention that are either designed to facilitate or to enforce the reduction or extinction of such behaviour. It is not clear, however, the extent to which such interventions are successful in achieving their avowed goal. This paper critically reviews the treatment of self-injurious behaviour, including work which takes psychodynamic, psychopharmacological, developmental, self-stimulation or learned behaviour perspectives, in order to establish the current status of interventions in this area. It is concluded that no single treatment approach has been shown to be effective in facilitating a reduction in the self-injurious behaviour of all clients. Rather, individualized programmes of intervention need to be constructed, using careful causal and functional analyses of behaviour. Moreover, such programmes, which may be multi-modal in nature, need to aim for interventions that are minimally or non-aversive.

Two experiments are reported in which patients who resided on continuing care psychogeriatric wards were exposed to an operant conditioning procedure. In the first experiment, the subjects were three female patients, all of whom were suffering from severe dementia. For two of the subjects, extended acquisition training was required before evidence of learning was found. Responding under fixed interval (FI) schedules of three different durations was well maintained by the third subject. Evidence of temporal control was found. The second experiment was a partial replication of the first. The subjects were two male patients who were suffering from mild to moderate degrees of dementia. They were exposed to FI schedules of three different durations. Responding was maintained for the 16 sessions of the study. Procedural modifications as well as some broader implications of these results are noted.

This study examined the efficacy of training parents in different methods of child management, using social learning theory/behavioural principles. Following an encouraging pilot study, thirty-seven pre-school children, six girls and thirty-one boys, were allocated to one of four methods of parent training: group, home visit, telephone, or waiting list/delayed intervention control. Assessment conducted pre- and post-intervention and at twelve to eighteen months follow-up indicated clinical improvement for all three active intervention conditions compared to the waiting list control condition. There were no significant differences between the three active intervention conditions either at post-intervention or at follow-up. Results are discussed in terms of their theoretical and practical implications.

This paper describes the use of cognitive behaviour therapy (CBT) with 24 chronically depressed in-patients. These individuals had previously failed to respond to all other standard antidepressant treatments and had been persistently depressed for at least two years. The clients were divided into two cohorts. The first (n=8) received a standard CBT package of 15 sessions combined with pharmacotherapy. The second cohort received a combined treatment, but the style of delivery of CBT was changed to try to take into account the special needs of the client population. At 12 weeks, 70% of the second cohort of clients showed a greater than 50% change on their pre-treatment objective and subjective depression ratings. The implications of these findings are discussed and further therapy trials in this difficult-to-treat population are encouraged.

Growing interest in the form and function of “social support” led to three small studies involving comparisons between behaviour therapists and social supporters (hair stylists) in terms of the help they provided with clients' emotional problems. The first compared observations of both groups in interaction with their routine clients, finding some overlap in their speech form (e.g. “reassurance”) but that overall the groups provided significantly different forms of help. The second study, based on a questionnaire survey, yielded similar results on the form of interactions between these groups and suggested in addition that their functions were distinctive. Together, these studies indicated that therapists and stylists differed in the form and the function of their helping work with clients. The final study went on to examine how behaviour therapists could help stylists to develop their social support role, finding a significant training effect and evidence of its generalization to clients. Implications drawn include enhancing the distinctive role of behaviour therapists in such “community care” interventions.

This paper builds on the suggestions of Samson and McDonnell (1990) concerning functional analysis and challenging behaviour and argues that although presenting an excellent outline of the general use of functional analysis, Samson and McDonnell (1990) have failed to sufficiently address the complexities of a functional approach to complex behaviour. The present paper emphasizes the need for caution when including “unobservables” in a functional analysis and discusses the contextual nature of the functional relationships between variables.

Research into the operant determinants of self-injurious behaviour (SIB) in people with learning difficulties has largely concentrated on the reinforcing effects that the behaviour of others may exert on the occurrence of SIB. In this single case study, the effects of SIB of differential severity on the behaviour of others are considered. The results of continuous, direct natural observations show social contact to be more likely to follow long bursts of SIB than short bursts and to be presented intermittently during and following long bursts of SIB. The implications of this finding for the functional analysis of SIB and the long term maintenance and development of severe SIB are discussed and related to the establishing operations and contingencies which govern the behaviour of the participants in the interaction.

The study set out to evaluate an individual parent training programme implemented by nursery staff. The experimental group was made up of eight mothers and their pre-school children. A matched group of nine mothers underwent group parent training, and a control group (N = 11) were given simple reading material on child development and took part in a discussion group. Pre- and post-test measures on maternal self-esteem (SES), parental attitude towards children (PAS), and knowledge of behavioural principles (KBP) were completed by mothers in all groups. A pre-school behaviour checklist (PSBC) was administered by staff on all children at the nursery whose mothers took part in the project. Results indicated a significant improvement pre- to post-test: (1) in PAS and KBP for the mothers who had undergone individual parent training; and (2) in PAS, SES and children's scores on the PSBC for those who took part in the group training. Whether or not mothers were living on their own was found to be a confounding variable on two of the measures. The implications of improved maternal self-esteem in the group, but not the individual setting, and an increase in knowledge in the individual, but not the group setting, are also discussed.

Social skills role-play assessment has been plagued by a lack of external validity. One solution recommended has been to select role-plays that are personally relevant for clients. The present study assessed the relationship between the personal relevance of role-plays and degree of socially skilled behavior. Results failed to support the hypothesis that clients would perform most poorly in those role-plays they viewed as most personally relevant. Results suggest that it may not be critical for therapists to develop role-plays that are personally relevant; the variables controlling socially skilled behavior do not seem unique to personally relevant situations. Instead, it may be more important for therapists to examine a broad range of social situations. If only personally relevant social skill situations are assessed, an incomplete picture of a client's range of social deficits may be obtained.

The main aim of this study was to evaluate pet therapy in terms of increased interaction with two groups of elderly psychiatric patients. These patients were different in respect of their diagnosis, but their environments were similar in layout, decor and facilities. Each group of patients was observed by an independent observer, and further rated by the ward nurses on a scale which recorded change in their behaviour over the three conditions: baseline, dog intervention and photographic intervention. The total time of observing was four weeks where the baseline (i.e. “normal” amount of interaction) and the two intervening stimuli were introduced, and compared with one another. Time sampling was used throughout the study. The results indicate that the dog intervention was the most effective in increasing interaction when comparisons were made with other conditions.

This paper presents data from a sample of 21 pilot cases and six control cases arising from an ongoing project evaluating cognitive-behavioural therapy in two-plus-one sessions within an NHS clinical psychology department. The major issue addressed concerns the general effectiveness of the two-plus-one-model as an ethical intervention model within a service delivery system. It is concluded that the data provide ethical and clinical support for a major field study as well as indicating provisional support for the implementation of this service delivery model in NHS settings in pursuance of more cost-effective models of psychological interventions to selected clients.

Samson and McDonnell (1990) proposed a definition of the term functional analysis. In a reply to that article, Jones and Owens maintained that Samson and McDonnell had failed to address sufficiently the complexities of this approach, particularly in the use of unobservables in functional analysis and the contextual nature of challenging behaviours. This paper attempts to provide a short reply to these contentions.

Forty-nine obsessive-compulsive ritualizers had clomipramine and live exposure in a randomized controlled design. The effect on outcome of pre-treatment expectations from psychological and from drug treatment and of subsequent compliance with exposure instructions was studied. Exposure instructions led to greater pre-treatment expectations than did anti-exposure instructions, but this did not affect outcome, suggesting that the effect of exposure was not due to expectation. Initially, more ill patients expected more from drug but improved less. Compliance with psychological treatment did not predict better improvement, but most patients were fairly compliant.

A training course designed to prepare staff to run stimulation groups for people with profound learning disabilities is described and evaluated. Nursing staff attending the day workshop improved significantly more than a control group in their attitudes, knowledge and skills (a simulated performance test) in relation to appropriate stimulation for this group. A profile of pre-training attitude, knowledge and skill is provided for different staff groups and it is shown that, prior to the workshop, nursing assistants had significantly more negative attitudes to such activities than trained staff or those in training. While each staff group improved on attitude and knowledge tests, nursing assistants alone failed to show post-training skill improvements. The practical implications of the results are discussed and the usefulness of the three measures assessed.

This paper responds to the comments of McDonnell and Samson concerning the Jones and Owens article which raised some issues related to the use of functional analysis in challenging behaviour. It is concluded that there is considerable agreement between the authors of both papers. The present paper raises some brief questions concerning the issues of a “correct” functional analysis and discusses dispositional characteristics in functional terms.

Long-term maintenance of weight loss is generally poor after clinical interventions, whether behavioural, cognitive-behavioural, dietary, pharmacological or surgical. This may be because self-assertion regarding body shape and self-efficacy in weight control are insufficiently encouraged in clients. Semi-structured group therapy sessions with written handouts were therefore designed to strengthen personal effectiveness and self-esteem. The therapy sessions also provided information about successful dieting behaviour, and encouragement of less switching between dieting strategies, less emotional eating, and more resistance to inappropriate social pressures. The clients were 24 women with a median (range) Body Mass Index of 28.9 (24.6–48.5) kg/m2, referred by their General Practitioners or self-referred. They participated in eight weekly therapeutic sessions in four groups and were followed up six months after the final session. There were large improvements during therapy in reported self-esteem, emotional overeating, personal effectiveness and self-efficacy, habit variation, and attitudes to body-size, improvements which were maintained at follow-up. In addition, there was a significant loss of body weight during therapy, with further loss observed at follow-up. Thus it is practicable to achieve marked reductions in professed problems with body image and eating control, changes that are theoretically necessary to empower clients to choose appropriate weight targets and to make progress towards them.

In the past, aggressive behaviour shown by people with learning difficulties has often been reduced by means of punishment. A non-punitive alternative to punishment is Differential Reinforcement of Other Behaviours (DRO). However, there is no evidence that DRO can be used to reduce target behaviours that are less frequent than once or twice a day. A case study is presented in which DRO is used to reduce aggression in a lady who was aggressive once or twice a month. The factors that may have led to the effectiveness of DRO in this case are discussed.