Behavioural family intervention (BFI) as a treatment approach emphasises the importance of family interaction patterns in the origins, maintenance, and treatment of child behaviour problems. The BFI Field can document substantial contributions to the development of more effective treatments with children, particularly those with conduct problems. Furthermore, this approach is now being applied to new areas with encouraging results (eg. pain, chronic health problems, anxiety disorders, and learning difficulties). There is increasing evidence that this technology is not a panacea and that good clinical outcomes can be difficult to achieve when children's problems are complicated by other indices of family adversity (eg. marital discord, maternal depression, alcohol abuse, or poverty). This special issue of Behaviour Change documents recent developments in BFI which attempt to improve outcomes with high risk groups. Applications of BFI with depressed and marital distressed parents and with children who are developmentally disabled, anxious, or have learning difficulties, are discussed. Finally, the issue points towards the use of BFI as a strategy for preventing disruptive behavioural disorders in children.

The area of psychosexual dysfunction in the elderly has been relatively ignored and very little research has been conducted into the aetiology, assessment, and treatment of such disorders. Many negative attitudes have been held traditionally relating to the sexual behaviour of older people, and this may account for the reluctance of many elderly clients to seek help, and for the lack of attention paid by helping professionals. The number of referrals for sex therapy from older persons is now beginning to increase, and evidence confirms that the majority of healthy older persons remain sexually active and sexually capable throughout their later years. Although there is a marked lack of empirical research, case studies suggest that cognitive-behavioural approaches offer promise in the treatment of psychosexual dysfunction in the elderly. Factors are discussed that relate specifically to older clients in the application of a cognitive-behavioural approach to assessment and therapy.

The present study tested the hypothesis that involving the partners of headache sufferers in a group cognitive-behavioural stress-coping intervention for chronic headaches would enhance treatment outcome. A treatment program in which partners were involved (PI) was compared with a standard treatment program in which partners were not included (NPI) and a no-treatment control condition (NTC). The NPI condition was effective compared to the NTC condition, but there was less evidence that the PI condition was effective. No significant differences were found between the PI and NPI conditions at posttreatment or follow-up. These results are considered in terms of the usefulness of involving partners in group headache-treatment and the manner of their involvement. In addition, the possibility that partner involvement may actually detract from treatment effectiveness is discussed in terms of its impact on motivation and personal responsibility for change.

The field of child clinical psychology has benefited from the development of behaviour therapy. One of the most important contributing areas is that of behavioural family intervention. Some of the contributions and achievements of this area are considered. Limitations and future directions are discussed.

Four adult, moderately intellectually handicapped persons who lived independently in the community were trained in safe exiting from their bedrooms in the event of fire. Baseline levels of competence were low, typically less than 20% of steps correct. Training was introduced to each trainee following a multiple probe across subjects design. Failures to complete a step were followed by video prompting in which the trainee watched a video of a model (an intellectually handicapped male) demonstrate the correct performance of the step. Acquisition required at most 10 sessions, the skills transferred to another residence and to the trainee's bedroom, and were maintained at 5 weeks.

Self-instructional materials are widely used to help smokers develop cognitive-behavioural techniques which may assist them to stop smoking. The effectiveness of these materials may be augmented by a minimal therapist support component to encourage and supervise their use. Forty-five smokers were recruited to a smoking-cessation program at a community health centre, and were randomly assigned to either a self-instructional manual plus regular telephone contact condition, or to a manual-only condition. A higher proportion of participants in the telephone contact condition reported being abstinent at 3- and 6-month follow-ups, but not at a 12-month follow-up. There were no differences between the two conditions for the smoking rates of the remaining smokers at each of the follow-ups. Levels of adherence to the techniques presented in the manual were generally low, with a preference for the more-simple behavioural techniques, and those which were related to initial behaviour change rather than to maintenance. There was no relationship between levels of reported adherence to the techniques and smoking status at follow up. There is the need for further research on the cost-effective use of social support strategies to augment the impact of self-instructional behaviour-change materials.

This study compared the effectiveness of prompts (signs) and posted feedback as litter control strategies in two university cafeterias. Patronage and litter rates were monitored daily throughout the second term of the academic year. Prompts, prompts and posted feedback, and posted feedback were presented sequentially within a multiple baseline across settings experimental design. While litter rates initially declined in the presence of prompts, the addition of posted feedback did not have an additive effect; however, subsequent removal of prompts produced further reductions in litter rates, which were still evident during follow-up 5 weeks later. Results suggest that posted feedback is an effective and inexpensive method of Utter control.

This study evaluated a behavioural treatment package for simple phobias in children using a multiple baseline design across subjects. The participants were three adolescents presenting with a principal DSM-III-R diagnosis of Simple Phobia. One participant also met the criteria for Separation Anxiety Disorder. Results showed marked improvement (at posttreatment and 3 months follow-up) of the anxiety for all three adolescents, both at overt-behavioural and cognitive levels with no negative effects on family and dyadic adjustment. Theoretical considerations and prognoses are discussed.

Forty-five university students were assigned on a sequential basis to either a face-to-face or a self-help exercise program for 12 weeks. Pretests and posttests included anthropometric and physiological variables, field tests of aerobic capacity, and psychological variables which had previously been identified as predictors of adherence to exercise. Both groups showed significant increases in aerobic capacity and reported increases in general well-being, suggesting that self-help programs may be as effective as more structured interventions in facilitating exercise. However, self-reports 12 weeks later suggested that maintenance was quite poor for both groups. Measures of body composition showed few changes over 12 weeks. Psychological variables generally failed to predict success with either program. It is suggested that variables derived from narrowly social-cognitive approaches to health-related behaviour change may fail to take account of social and environmental constraints which may be important in understanding and predicting maintenance with health-related exercise.

This report explores the role of parental depression in the adjustment of children and discusses its implications for behavioural family intervention. Within a social interactional perspective, depression is conceptualised as a class of behaviours that is under the control of the social environment and at the same time operates as a context for other social agents. The presence of this class of behaviours in parents is postulated to precipitate developmentally determined psychological problems, that is based on a child's age and sex, such that younger boys and adolescent girls would be most at risk. The results of two longitudinal studies are presented showing a significant relation between fluctuations in mothers' depressive symptoms and similar symptoms in their adolescent daughters. Weaker effects are seen between fathers' and sons' depressive levels. The implications for behavioural family therapy are discussed in relation to depression in adolescent girls.

We examined the covariation of stereotyped behaviour and engagement in persons with profound intellectual and physical disabilities. Data are presented on the rates of stereotyped behaviour and engagement immediately prior to, during, and immediately after training sessions aimed at increasing manipulation of entertainment materials such as toys. The results indicated that (a) training was successful in achieving increased engagement, (b) stereotyped behaviour decreased when the level of engagement increased, even though stereotyped behaviour was not incompatible with engagement, and (c) after training ceased, stereotyped behaviour increased to higher levels than baseline and engagement decreased to below baseline levels.

Much research has demonstrated that marital discord and divorce are risk factors for the development of childhood behavioural and emotional disorders. Although theoretical models and research programs that focus attention on possible mechanisms of influence are scarce, it is clear that marital discord can powerfully influence children via its effect on spouse's parenting behaviour. Thus, marital discord can represent a significant impediment for intervention programs that aim to help children by providing parent training. It is argued that marital and child focused interventions can be successfully integrated in behavioural family therapy. A description of the process and content elements of such an integration is presented, and future directions for research and practice are discussed.

Short-term social judgments that involve avoidance can contribute to the production of a habit that forecloses on later adaptation. When a child uses avoidance in one setting, and then in another, the child may have already begun the foreclosure process. Short-term decisions have long-term consequences, and to reduce anxious avoidance in youth is to increase long-range opportunities. Teaching behavioural and cognitive skills to increase social competence and adaptation will increase opportunities and increase choice. In the ideal situation, the plan is to encourage the development of coping skills, to encourage the family and the school to provide opportunities for coping, and to encourage the social system to provide the rewards that will maintain nonanxious nonavoidant behaviour. The thrust of this presentation is (a) to review and integrate behavioural and cognitive theories that guide us to understand the nature of anxiety in youth, (b) to describe intervention strategies that build childhood coping, and (c) to consider the necessary environmental changes that are needed to maintain treatment-produced gains.

This study investigated the effectiveness of posted feedback as a litter control strategy in a university cafeteria. Patronage and litter rates were monitored daily throughout the second term of the academic year. Posted feedback was effective in reducing litter rates relative to baseline. Reductions in litter rates were maintained following intervention and continued to be evident 2 weeks after the completion of the study. Results support previous findings that posted feedback is a simple and effective method of litter control.

A vocal tic, manifested by a persistent throat-clearing cough, was treated using the habit reversal procedure which was modified to include cognitive therapy. Treatment outcome was assessed using video recordings of tic frequency and self-report measures of anxiety, tic occurrence, and associated disruption to normal living. The treatment was very effective in alleviating the tic, with improvement maintained at 6 months follow-up. These findings indicate the need for further research to establish the usefulness of targeting cognitive processes in the treatment of tic behaviour.

A case study is presented of a 20-year-old male who experienced marked increases in body temperature and profuse sweating of the forehead and trunk when in formal social situations. No other physiological nor psychological manifestations of anxiety were admitted to and no situational avoidance was reported. Pretreatment, posttreatment, and follow-up self-report measures and daily self-monitoring of intensity and frequency of sweating were collected to evaluate treatment effects. Treatment was conducted over a period of 20 weeks. Cued conditioning and desensitisation were initially employed, however treatment effect was difficult to determine. The effects of an inadvertent in vivo exposure in week 6 of treatment and the subsequent change in treatment to exposure and cognitive therapy are discussed. The positive effects of treatment, which led to a decrease in the frequency and intensity of the sweating response, were evident at the completion of treatment and well maintained at 60 weeks follow-up. The use of exposure and cognitive therapy as a suitable treatment for this disorder are discussed in light of other anxiety disorders.

During the past decade there has been a major advance in clinical management of schizophrenic disorders (Falloon & Shanahan, 1990; Lam, 1991; Schooler & Hogarty, 1987). This has resulted from application of strategies based upon a vulnerability-stress model of mental disorders. This considers mental disorders to result from interactions between specific biological vulnerability and non-specific environmental stresses (Falloon & Fadden, 1993).

Therapeutic interventions derived from this model combine biomedical strategies, predominantly optimal pharmacotherapy, with psychosocial strategies that aim to enhance the capacity of the index patient and his/her social network to cope with the impact of environmental stresses on the course of the disorder. Ten controlled studies have been published since 1980 that meet minimal standards of research design, with follow-up for at least 1 year (Bellack, Turner, Hersen, & Luber, 1985; Falloon, 1985; Gunderson et al., 1984; Hogarty et al., 1986; Leff, Kuipers, Berkowitz, Eberlein-Fries, & Sturgeon, 1982; Leff et al., 1989; Malm, 1982; McFarlane, 1990; Tarrier et al., 1988; Wallace & Liberman, 1985). Nine also provided 2-year results. Overall, these studies show that the addition of psychosocial strategies to optimal case management and long-term drug prophylaxis halves the rate of major clinical exacerbations in people suffering from schizophrenia. This benefit is most notable during the first year after a major schizophrenic episode, particularly when the psychosocial interventions encompass patients' immediate social support systems, usually the family or marital household (Falloon, 1985; Hogarty et al., 1986; Leff et al., 1982; Leff et al., 1989; McFarlane, 1990; Tarrier et al., 1988).

Described here is a brief history and critique of behavioural parent training, followed by a description of an ecobehavioural approach to families with children with developmental disabilities and families involved in child abuse and neglect. A definition of ecobehavioural is provided, along with suggestions for future research.

A 37-year-old male with a 13-year history of atopic dermatitis (AD) was treated with cognitive behavioural stress management. Self-rated stress and extent of AD rash decreased from baseline to the end of treatment, and gains were maintained at follow-up. A significant correlation between stress and extent of AD rash was observed. Discussion focused on the possible role of stress induced immunosuppression on exacerbations of AD, and the need for controlled trials evaluating the treatment procedures used in the current study.