Generalized anxiety patients were randomly allocated to Cognitive-Behaviour Therapy, Diazepam or Placebo and managed in a primary care setting. Treatments were balanced for degree of psychologist/patient contact. A range of outcome measures, including patient self report, psychologist assessor and general practitioner ratings were used. Large variations within group response to treatment emerged. At the end of active treatment the superiority of Cognitive-Behaviour Therapy was suggested. Post-study psychotropic prescription and psychological treatment was assessed at a 12-month follow-up. The Cognitive-Behaviour group revealed the lowest incidence of subsequent treatment interventions.

True rapprochement attempts should be welcomed as initiatives to promote understanding between different theoretical positions and in the interest of parsimony. Persuasion attempts to achieve behaviour change, based on the moral imperative, should be inspected very closely indeed.

Twenty-nine outpatients (24 men) with a history of problem-drinking and alcohol dependence were assigned at random to one of three covert sensitization procedures varying in the nature of stimulus elements in aversion scenes. Group 1 received standard nausea imagery, whereas Group 2 received similar scenes “assisted” by noxious odors. Imagery used in Group 3 scenes was unrelated to nausea but focused instead on disturbing potential consequences of drinking. The occurrence of conditioned aversion responses (CR) was verified by observational, self-report and physiological measures. The observed pattern and frequency of conditioning corresponded closely to data reported by Elkins (1980). Favourable outcomes at 18 months (abstinent, controlled or improved) were observed in 45, 56 and 67% of clients in each group, respectively. The groups did not differ significantly in effectiveness. Within both of the nausea sensitization groups (1 and 2), successful remission at 18 months occurred only in individuals who had shown CR, whereas in emotive sensitization (Group 3) there was no apparent relationship between conditioning and outcome.

It is argued that the attentional strategies of phobic patients have important consequences for how they cope with anxiety. The literature indicates that focused attention to anxiety cues is important for long-term emotional habituation but that it is made difficult by anxiety. Questionnaire studies of agoraphobics reliably identified factors concerned with attentional strategies of coping with anxiety, and showed that they were distinct from self-talk strategies. The effect of anxiety levels on the use and perceived helpfulness of these strategies was also explored. Finally, the implications of an attentional framework for exposure treatments of phobic anxiety are discussed. It is suggested that the questionnaire may be a useful way of measuring patients' attentional strategies in clinical work.

Our recent attempt (Emerson and McGill, 1989) to suggest a rapprochement between normalization and applied behaviour analysis has proven to be a contentious venture. Baldwin (1989) has made a case for dismissing our argument on the grounds that it is an attempt by “normalization advocates” to take over applied behaviour analysis. He suggests that, as we have made no case for this other than “simplistic de facto moralizing” (p. 307), our paper will be transparent to behavioural practitioners whose moral integrity, it is implied, we have assaulted. In contrast, Baldwin suggests that there is a case for applied behaviour analysis subsuming normalization, although this is considered problematic because of the weakness of the latter position and the “excessive zealotry, proselytizing and evangelizing” (p. 306) of its proponents (ourselves presumably included).

Single definitions of complex terms do not exist. Previous authors have identified one possible translation of “rapprochement”. Equally, other definitions exist: “to bring together, to approach” (Webster's Collegiate) or “a drawing together” (Chamber's Concise).

A clinically-oriented description is provided of the Discretized Analog or Discan method (Singh and Bilsbury, 1984) for obtaining reliable and precise measures of subjectively experienced dysfunction variables whose possible values form a continuum. The method can provide a 14-point ordered categorical scale with only four reference levels which represent some of the possible values of intensity of the variable. The process of Discan administration consists of a series of repeated comparisons of the true or perceived level with one or two reference levels at a time. It therefore allows for use of elaborate descriptive statements for reference levels. It is recommended following Shapiro (1961, 1975) that the reference levels be ideographic, ipsitive and should reflect ordered steps of recovery from the dysfunction. Discan overcomes several limitations of the commonly used rating scales. An application of Discan to the MSB relaxation technique is presented as an illustration.

It is becoming increasingly evident that informal psychotherapy plays a significant part in the coping strategies people use to alleviate personal distress. A form of this “social support” was evaluated in a pilot study in which ex-clients served as therapists for informal community groups made up of people experiencing clinical anxiety. Three major questions were addressed: what are the training effects of a short workshop on the ex-clients' social support skills?; can the trained ex-clients help people suffering with clinical anxiety?; and finally, does this involvement have an adverse effect on the psychological well being of these lay therapists. Between and within group analyses with multiple measures indicated that the workshop was successful in all three targeted areas. Implications are drawn for the pattern of formal psychotherapy services.

Generalized and social anxieties are common psychological problems which frequently coexist. The present study examined the efficacy of a multimodal therapy strategy for these problems. As there is no close correspondence between the three response systems in which anxiety is manifested, therapeutic strategies were selected for inclusion in the programme with the aim of targeting irrational cognitions, non-assertive behaviours, and physiological arousal. A battery of self-report instruments as well as a blood-pressure meter were used to monitor changes in these response systems. Questionnaires were rated by the 24 participants on two pre-and two post-treatment occasions. While significant reductions were found for nine questionnaires, no change was observed for blood-pressure levels. It was submitted that benefits of multimodal therapy can be best appreciated by giving attention to the number of areas of change produced in therapy as well as absolute levels of change.

Four dimensions thought to be basic to all child behavior therapy are specified. These are: (a) manipulation of the consequences of inappropriate behavior; (b) short-term prevention by ecological change; (c) teaching more appropriate alternatives and (d) long-term prevention by remedying more fundamental behavioral deficits. It is proposed that all four dimensions are needed for the design of any clinical treatment. The model therefore illustrates how ostensibly opposing intervention strategies in behavior therapy are really complementary. Since children's clinical problems rarely occur as isolated behaviors, and since behavioral psychotherapy involves development of more adaptive skills that influence the target problems indirectly, the dimensional model allows cross-referencing of the interrelated target behaviors in the child-client's repertoire. This is illustrated by describing typical intervention designs for two children with behavior problems. By formally specifying the realities of clinical treatment design, the relevance of therapy outcome research to clinical practice should be enhanced.

This paper describes and compares two relaxation training procedures with moderately and severely mentally handicapped people. Abbreviated Progressive Relaxation is a widely used procedure while Behavioural Relaxation Training is a relatively recent development which the authors felt might be more suitable for mentally handicapped people since it does not require a conceptual awareness of internal states of anxiety. While both relaxation procedures produced improvements, Behavioural Relaxation Training was significantly better than Abbreviated Progressive Relaxation. In addition to this the results during treatment showed Abbreviated Progressive Relaxation to produce very variable effects from session to session. In contrast the effects of Behavioural Relaxation Training were quick and consistent.

It is argued that normalization and applied behaviour analysis represent the most significant developments of the past two decades in approaches to the design of services for people with learning difficulties. Problems in translating these approaches into practice have been compounded by an apparent conflict between them. The nature of this conflict is examined and suggestions for a rapprochement are made.

The functions of resistance and restraint are considered in three topographically distinct psychological disorders that are characterized by excessive behaviour. Certain similarities are observed and speculations about their common role are examined. Finally attention is drawn to the implications of this type of analysis for our understanding of such disorders and for psychological treatment.

The present study was carried out to evaluate the effectiveness of psychological methods on the group treatment of insomnia. Assessments were administered on measures of general and physical health, symptoms associated with anxiety and benzodiazepine usage and specific measures related to sleep pre- and post-treatment, and at a one year follow up. Fifteen patients were referred from GPs in one practice, and were sequentially assigned into three groups. Treatment took the form of 11 to 13 sessions of weekly group therapy. The group treatment consisted of (1) cognitive-behavioural strategies, including sleep monitoring, stimulus control, cognitive restructuring, problem solving, anxiety management and progressive relaxation; (2) sleep education; (3) gradual drug withdrawal. The results indicated that immediate post-treatment improvements on measures of general health, symptom reduction, reduction of hypnotic-sedative medication, and on the quantity and quality of sleep were maintained after an interval of one year after treatment. Insomnia was less severe, less frequent, of shorter duration and more easily managed. However, there were no improvements on measures aimed to assess general coping strategies nor on measures of sleep maintenance insomnia between the three periods. The findings and implications for future research in this area are discussed.

The difficulty in predicting outcome from therapist behaviour has been attributed to the neglect of some important variables, including the amount and type of therapy, and the skilfulness and interpersonal manner of the therapist. The present study investigated one therapists behaviour in terms of these four dimensions for a random sample of 10 adult outpatients, for whom outcome data were available. Results indicated that the type of therapy was intermediate between prescriptive and exploratory modes, that it was practiced at a satisfactory level of proficiency, and that interpersonal effectiveness was high. The related Clinical outcomes were also satisfactory in relation to the amount of therapy. In addition to illustrating a procedure for evaluating therapist behaviour and showing the correspondence between process and outcome, this “case study” provides evidence to support the need for more objective accounts of therapist behaviour.

In a series of 51 previously sexually abused women who entered therapy 94% were found to be sexually dysfunctional. It is proposed that these dysfunctions may stem from certain mood disturbances, interpersonal problems, and sexual stresses, that are associated with the earlier traumatic experience of sexual abuse and its surrounding circumstances.