The present review concerns the relative efficacy of imaginal and in vivo flooding in the treatment of debilitating fear. It has generally been concluded that in vivo flooding is superior to flooding in imagery. However, in the present review, serious methodological weaknesses were found to exist in a number of studies which have been frequently cited as demonstrating the superiority of in vivo flooding. In addition, recent empirical studies are reviewed which cast doubt on the belief that in vivo flooding is superior to imaginal flooding. Overall, little support was found for recent recommendations advocating the abandonment of methods of imaginal exposure in the treatment of clinical fear.

Although there have been a vast number of reports on training direct care staff in behavioural techniques, little work has been reported pertaining to elderly individuals. This paper describes how a method of constructing, implementing and evaluating individual plans – goal planning – was adapted for use with elderly clients. Direct care staff in a number of different establishments were trained in goal planning techniques with elderly clients and evaluations of their goal planning skills were made after training. Most trainees acquired the skills to an acceptable level and in the small sample studied, this was maintained at four month follow-up. Some measures of the effectiveness of the implementation of the goal planning and its maintenance after training are reported, and limitations of the training programme are discussed.

Cognitive behavioural treatment for chronic pain was individually tailored based on pre-treatment assessment of the subjective pain experience of each patient. Eight chronic pain patients completed the individualized treatment program which consisted of relaxation techniques, hypnotic deepening strategies, a relabeling hierarchy based upon pain descriptors, positive self-statements, didactic information, and cognitive-restructuring techniques. Patients self-monitored their pain during a two week pre-treatment baseline period, during the eight weeks of treatment and for one week post-treatment. Additional treatment outcome measures were also taken. Compared to baseline data, patients reported positive changes on many of the treatment outcome criteria, including McGill Pain Questionnaire indices, reduction in the number of hours spent in pain, and follow-up questionnaire responses. Treatment outcome measures collected at one week, six months, and 15 months post-treatment all suggested positive treatment gains. The greatest gains were reported at the six month post-treatment assessment suggesting a generalization or practice component to the therapy. Additionally, patients with constant pain were found more refractory to treatment than patients with intermittent pain.

Although covert conditioning procedures are widely employed by behavior therapists, the literature is marked by considerable procedural variability and inconsistent results. Part of the problem is attributable to the lack of a generally agreed upon and experimentally supported theoretical account of covert conditioning procedures. Inasmuch as the procedural arrangements of covert conditioning techniques depend upon the underlying theoretical framework, it is important that the framework be experimentally supported. One prominent theoretical account of covert conditioning is the operant account proposed by the main proponent of covert conditioning, Joseph Cautela. As an explanation of the clinical effects of covert conditioning, however, Cautela's account has not been adequately tested. Two experiments were conducted, the purpose of which were to conduct laboratory analogue tests of Cautela's account of covert conditioning by examining the effects of covert reinforcement and covert punishment procedures on the subsequent free-operant rate of selected target responses of college students. The results failed to support Cautela's operant explanation of covert conditioning.

The effect of two treatments on a facial tic was examined experimentally. The subject, a 53-year-old male, carried out massed practice or relaxation for two periods of 5 min alternating with 5 min assessment periods during which he engaged in free conversation around key words. This was followed by a further two periods of the alternative treatment and intervening assessment periods. Pulse rate was monitored throughout and the procedure concluded with a 5 min period of covert assessment of tic frequency. Sessions were held on four consecutive days. Tic frequency was observed to increase following massed practice and marginally following relaxation. The latter treatment, however, was found to be effective in reducing tic frequency during the treatment block itself. The results are discussed in terms of the subject's general level of anxiety and the anxiety induced by the massed practice procedure.

Discharged psychiatric patients at a large community residence were noted to be experiencing increased agitation, anger and anxiety in connection with repeated vandalism and unauthorized visits by members of the surrounding community. An intervention based on behavioral concepts and technology was formulated utilizing many parts of the social matrix of the residence, including clinical staff, direct care staff and the residents. Resident behavior was successfully changed as a result of the intervention. It appears that behaviorally based, clinical-administrative solutions to “real world” problems can be effective in teaching passive, chronic mental patients safety conscious behavior and helping them to assume responsibility for their community-based living space.