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.

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.

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.

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.

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.

By means of a single case study, the effects of redirecting attention above exposure only on fear of blushing, avoidance, and idiosyncratic dysfunctional beliefs were tested. A social phobic patient with fear of blushing as the predominant complaint received sessions of Task Concentration Training (TCT) and Exposure in Vivo (EXP) alternately, after a steady baseline had been established. The treatment consisted of 14 individual sessions. Assessments were held before and after baseline, after treatment, after 4 weeks follow-up, and after 1-year follow-up. Continuous measurements were held throughout the treatment in order to measure the differential effects of TCT and EXP on fear, avoidance and beliefs. TCT and EXP together, turned out to be an effective treatment for fear of blushing: large effects were observed on all three outcome measurements. When differential effects are closely looked at, EXP seemed more effective in decreasing fear of blushing. However, the patient appeared to have used TCT strategies as well during the EXP weeks, which may have contributed to the favourable effects of EXP.

The Nijmegen Motivation List 2 (NML2) is a new instrument to assess patient motivation for psychotherapy. A previous version of the instrument was associated with positive treatment outcome in cognitive-behaviour therapy in several studies but its psychometric properties were poor. The present study investigated the NML2’s factorial structure, psychometric properties, and predictive value for treatment outcome. The NML2 was completed by 133 outpatients. Three factors were found: preparedness, distress, and doubt. Internal consistencies and re-test reliabilities of the factors were reasonable. The NML2 total score and preparedness were associated with proximal treatment helpfulness and with treatment drop-out. Distress and doubt were not. These findings corroborate those found with the earlier NML version. Rather than assuming that the relationship between motivation factors and treatment outcome is mediated by the amount or quality of treatment or homework compliance, it is proposed that motivation for treatment is the first step in the patient’s change process itself.

Psychiatrists, who are still performing the executive roles in many areas of mental health, make up 6.5% (N=184) of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) membership. Considering that there are currently 4577 practising psychiatrists in the U.K. (Consultants, Senior Registrars, Specialist Registrars, Associate Specialists and Staff grades), the above figure is put into perspective. The equivalent figure for clinical psychologists is 40.9% (N=1162) of BABCP membership, taken from a national total of 3734 qualified professionals. Viewed in this context, the present review examines the profile of cognitive therapy (CT) in British psychiatry during the last three decades. As a measure of this, it was decided to survey the number of articles on cognitive therapy appearing in two key psychiatric journals widely circulated in Britain: The British Journal of Psychiatry and Current Opinion in Psychiatry.

Memory aid groups have often been used as a method for teaching mnemonic strategies to older adults in early stages of dementia. This study describes the use of CBT to address unhelpful memory-related beliefs in three older men with mild/moderate dementia and associated low mood or anxiety. The members were able to participate and engage in the sessions, and changes in behaviour, cognition and affect were monitored over the course of a 7 week group intervention. Recommendations are made for further research.