A cognitive approach to auditory hallucinations that is based on the models of panic and anxiety developed by Clark (1986), Beck (1976) and Salkovskis (1991) is outlined. It is suggested that auditory hallucinations are normal phenomena, and that it is the misinterpretation of such phenomena that cause the distress and disability that are commonly seen in patients experiencing hallucinations with a diagnosis of schizophrenia. It is also proposed that these interpretations of auditory hallucinations are maintained by safety seeking behaviours (including hypervigilance). The existing literature is reviewed in relation to these hypotheses and found to be largely consistent. The clinical implications of such a model are briefly discussed and a number of testable predictions are made.

This issue contains the obituaries of two of the greats in our field, and itis tempting to regard it as the end of an era. Hans Eysenck and Joseph Wolpewere truly giants in the field, truly founding fathers of scientificcognitive-behavioural therapy. Their passing is a landmark, but clearlynot the end of an era. The era that they ushered in was one inwhich the basis of psychopathology and treatment lay in well defined theoryand rigorous, well conducted research. That philosophy has grown, developed,and has given us a scientific basis for cognitive-behavioural therapy.

I believe that it is no coincidence that both men intended, at an earlyage, to follow a career in the physical sciences. They had many othercharacteristics in common, including a firmness of purpose that served boththem and the field well. Isaac Newton, writing to Robert Hooke, said of hisachievements that “If I have seen further it is by standing onthe shoulders of Giants”. Eysenck and Wolpe were such giants, and we should be grateful for their shoulders, and for the visionthat their achievements allow us.

As I am sure you cannot have failed to notice, the Journal has taken onquite a different look, thanks to Cambridge University Press. In addition,there have been changes in the Editorial Advisory Board. We welcome some newmembers, and say farewell and thanks to some old friends. Members of the newEditorial Board are going to be very directly involved in advising theeditors and assistant editors in matters relevant to particular issues andgeographical regions.

It can be argued that an individual’s subjective experience and beliefsabout a substance are important. Motives and expectancies regarding the use ofalcohol and drugs are often that they are going to modify a cognitive state orhelp them cope with a particular situation. However, there are growing concernsin the U.S.A. and in the U.K. regarding individuals who experience psychosis andconcurrently use substances. Correctly diagnosing individuals with dualpresentation is said to be difficult, engagement in treatment is problematic, andmedication adherence and prognosis poor. In this paper a cognitive-developmentalmodel is proposed. I suggest that for individuals who experience psychosis andalso use drugs or alcohol, the ability to identify the relationship between thesubstance use and the psychotic illness in terms of a case formulation/conceptualizationwould provide a good starting point for developing strategies and interventionsthat are most likely to succeed in treatment. Such an approach would explicitlyaddress key cognitions. Unless the dysfunctional substance-related beliefs areaddressed, adherence to medication and engagement with treatment services willbe hindered and the possibility of relapsing to problematic substance use andacute psychosis remains. A cognitive treatment component, to target these beliefs,based on the cognitive model of substance misuse and the motivationalinterviewing approach will also be briefly outlined.

Psychological treatment that reduces anxiety has been found to be beneficialto benzodiazepine withdrawal. High drop-out and relapse rates, however, havealso been reported. They might be due to a heightened anxiety levelmaintaining the drug-taking habit or to the addictive potency of the drug,which is not addressed by the intervention strategies. In the present study,initial assessment data were compared among treatment refusers, drop-outsand completers – successful as well as unsuccessful ones – of apsychological treatment programme in support of benzodiazepinewithdrawal. Treatment refusers showed a more negative current mood statethan those consenting to treatment. Internal locus of control was predictiveof premature termination and unsuccessful completion of the treatment trial.Neither medication-related variables nor anxiety or depression were found toinfluence the success of treatment. Perceived control over medication intakeis thought to reduce compliance with the treatment regimen – a patternthat may be consistent with the addiction hypothesis.

Recent “Power Therapies” claim near miraculouscures but fare less well under controlled testing. These developments recallfor cognitive behavior therapists the history of past “cures” thattemporarily induced high levels of expectancies, but failed the test of time.

Previous research on vulnerability to Post-Traumatic Stress Disorder (PTSD)has been restricted by the absence of prospective studies that measureindividual differences prior to traumatization. This study investigatedthe predictors of analogue post-traumatic intrusive cognitions using afully prospective design. Non-patient participants completed a range ofpredictor measures before being exposed to a film about a traumaticfire. Film-induced changes in negative mood were also assessed. Subsequentintrusions were measured both within the experimental session and for afurther seven days. The hypothesized predictors were: neuroticism, traitanxiety, extraversion, depression, a general tendency to suppress unpleasantthoughts, beliefs about being “at risk” from fire, mentalimagery, self-rated proneness to intrusions and negative mood changes. Theresults showed that intrusions were predicted by film-induced increases innegative mood, thought suppression tendencies, beliefs about vulnerabilityto fire and self-rated proneness to intrusive cognitions. The findings arediscussed in relation to the literature on thought suppression andcognitive processes in PTSD.

A recent cognitive model of social phobia (Clark & Wells, 1995)suggested that negative self-images may play an important role inmaintaining the disorder. To investigate this suggestion, 30 social phobicsand 30 non-patient controls were given a semi-structured interview whichfocused on spontaneously occurring images. Social phobics were significantly more likely than controls to report experiencing images when anxious insocial situations. In addition, social phobics’ images weresignificantly more negative and significantly more likely to involve seeingoneself from an observer’s perspective. Implications of these findings forthe understanding and cognitive treatment of social phobia are discussed.

Recent discussion has emphasized the importance of assessments of clinicalsignificance of outcome in treatment outcome studies. Several methods existto assess clinical significance, one of which is the use of global ratingsof outcome. This study reports the use of such measures in a treatmentoutcome study investigating pharmacological and psychologicaltreatments for panic disorder and agoraphobia in primary care. Outcome isreported in terms of global ratings of symptom severity and of change insymptoms following treatment, completed by the psychologist, referringGeneral Practitioners (GPs) and patients. Treatments involving cognitivebehaviour therapy showed greater efficacy than those employingpharmacological treatments alone. Considerable agreement was demonstratedbetween psychologist and patient ratings. Such agreement was much lessobvious for ratings completed by referring GPs. Possible reasons for thisare advanced.

This study investigates whether large-scale, day-long stress managementworkshops open to the general public can work as well as small, weeklygroups run for referred clients. It is suggested that the self-referralroute may enable some people who might otherwise have been‘‘filtered out’’ from the traditional health servicesto get help for their stress-related problems. Analysis showed that thelarge-scale format was just as effective with a more distressed subgroup aswas the small weekly format for formally referred clients, which suggeststhat the effectiveness of this approach is not only related to a restrictedclient group. It would appear that the low drop-out rate, the effectivenessof the workshops and the severity of problem handled within this formatindicates potential value in this type of approach.

Childhood phobias are complexly determined but responsive to behavioralinterventions. This review focuses on emotive imagery, a variant ofsystematic desensitization developed specifically for use in treatment ofchildren’s excessive fears. Although emotive imagery appears to be a usefultreatment procedure, further research is needed before it could be consideredas having “well-established” empirical status. Several otherimportant methodological and theoretical issues are emphasized.

A substantial literature now exists that indicates that cognitive-behaviour therapies are effective for a wide range of psychological problems (See Hawton, Salkovskis, Kirk, & Clark, 1989). However, it is only very recently that cognitive-behaviour therapists have considered people with learning disabilities as suitable clients for this particular approach. The present paper describes some of the challenges that are encountered when applying cognitive-behaviour therapy to this client group.

Morbid jealousy is a potentially disruptive condition that has receivedlittle attention. A cognitive-behavioural formulation of morbid jealousyproposes that such individuals possess schema in which there is a perceivedthreat of loss of their sexual partner. An attentional bias in morbidjealousy was investigated by using a dichotic listening task and themodified Stroop test. Twenty subjects who had met criterion for morbidjealousy were compared with 20 control subjects. In the dichotic listeningtask, word pairs were presented to each ear simultaneously, and subjectsshadowed one channel while identifying target words. Ten percent of thewords presented to the non-attended channel were target words, of whichhalf were jealousy-related and half were not. Subjects were not told thatthe target words were only presented in the unattended channel. In themodified Stroop test, subjects had to name the colour of a series of Os,colour words, emotional words, control neutral words and jealousy-relatedwords. As predicted, jealous subjects showed a superior performance indetecting jealousy-related stimuli in the dichotic listening task and animpaired performance in the colour naming of jealousy-related stimuli inthe modified Stroop test, compared to the control subjects and the controlconditions. The results of this study add support to the formulation thatmorbid jealousy involves an attentional bias towards jealousy-relatedinformation and this may have clinical implications.

The relative efficacy of cognitive restructuring and interoceptive exposureprocedures for the treatment of panic disorder, as well as the differentialeffects of the order of these interventions, was studied. Eighteen clientswith panic disorder were seen for four sessions of exposure therapy and foursessions of cognitive therapy in a crossover design study. Half of theparticipants received exposure therapy followed by cognitive therapy and forhalf the order was reversed. There was a 1-month follow-up period between the two interventions and after the second intervention. Questionnairemeasures and independent clinician ratings were used to assessoutcome. Participants expected greater benefit from cognitive therapy, buttended to improve to a similar degree with either intervention. The order inwhich treatments were presented did not influence outcome. Participantstended to improve with the first intervention and maintain improvementacross the follow-up periods and subsequent intervention. Severalmethodological limitations qualify the conclusions that can be drawn fromthis study. These limitations, as well as some conceptual and methodologicalchallenges of conducting this type of research, are discussed.

Research aimed at identifying genes contributing to the aetiology ofpsychological disorders is in progress. This raises the possibility thatgenetic testing for such genes might become available. In this paper thepossible psychological consequences of genetic testing for psychologicaldisorders are examined. It is proposed that genetic testing may causepsychological and behavioural reactions that actually increase theperson’s risk of developing a psychological disorder or may maintainexisting problems. It is also suggested that cognitive-behavioural modelsmay be able to aid prediction of some of the likely consequences of testingand identify people who are likely to react in particularly negative ways tonews of their genetic risk. If genetic tests for psychological disorders are developed, it isimportant that research is carried out into the psychological and behaviouraleffects of testing and ways of minimizing adverse effects, before such testsbecome widely available.

While treatments for Generalized Anxiety Disorder have considerably improvedrecently, they remain less effective than similar treatments for otheranxiety disorders. This paper reports on a comparative outcome study of alarge group didactic therapy specifically designed to teach patients to“become their own therapists” in an attempt to counterthe relapse problems commonly associated with this condition. The data suggestthat improvements noted at six month follow-up are maintained at two years. Suggestions are forwarded to explain the lack of differential responding found amongdifferent therapy approaches.

The thorny issue of inappropriate authorship is a well recognized problem inresearch (Epstein, 1993). Recent editorials and articles in theBritish Medical Journal (BMJ), Lancet and Journal of AmericanMedical Association (JAMA) have raised its profile amongst our medicalcolleagues. The current authors feel that clinical psychologists, nursesand other mental health professionals need to be more aware of thecomplexities of the area. Hence this paper intends to clarify the majorconcerns regarding proper accreditation and gives some recommendationsand guidelines.

The French version of the Social Interaction Self-Statement Test (SISST) wasstudied in 95 social phobia and 87 non-clinical subjects. Total scores onboth positive and negative scales significantly discriminated social phobicsfrom non-clinical control subjects. Social phobics had higher scores thancontrols on negative statements and lower scores on positive statements. Thepositive and negative subscales of the SISST for social phobic patients werecorrelated with anxiety, depression and avoidant behaviours. The negativesubscale was significantly sensitive to change in patients with social phobiareceiving cognitive behavioural therapy. Our findings showed good convergentand discriminant validity of the SISST and the sensitivity of the negativesub-scale to improvement after cognitive behavioural therapy.

In order to test the efficacy of a self-help anxiety management package, 62anxiety disorder patients were randomly allocated to one of three conditions.“Stress-pac” patients were given a self-help package,“Advice Only” patients were offered verbal advice onways of coping. Patients in both conditions were seen on one occasion shortlyafter referral for assessment and management advice. They were then placedback on the waiting list for a three-month period. Patients in the“No Intervention” condition also completed measuresduring this time. They were formally assessed at the end of this period. Allpatients were then followed through therapy. Results from a previous paperclearly indicated the superiority of the Stresspac condition at all data pointsup to one year follow-up. This paper looks at three-year follow-up and, whilefinding generally good outcome across conditions, finds further evidence ofthe superiority of the Stresspac condition on a range of measures.

Social psychological models of reasoned action, and behavioural models ofverbal behaviour, predict that caregiver beliefs and attributions partiallydetermine their responses to challenging behaviours. The present studyexamined the relationship between special educators’ causal attributions andthe underlying function of challenging behaviours in children with learningdisabilities. Sixty special school staff were presented with two questionnairevignettes describing attention seeking and task avoidance behaviour. Theywere then asked to identify the likely causes of the behaviours. Onlya small proportion of participants made accurate causal attributions aboutthe two examples of challenging behaviour. In addition, staff experience hadlittle effect on the accuracy of attributions. Implications for futureresearch, for staff training, and analysis of challenging behaviours arediscussed.