Behavioural medicine has become a popular, important and distinct field of research and clinical practice. One of the more exciting areas of behavioural medicine has been in the application of behavioural techniques to reduce cardiovascular risk-factors on a community-wide basis. Work conducted in this area highlights a key issue for the development and support of behaviour analysis and modification activities in Australia: to what extent should behavioural practitioners and their interest groups pursue a specialised, behaviour-analytic approach to the areas in which they are involved, as opposed to adopting interdisciplinary frameworks and approaches. We describe some of the activities of the Stanford Center for Research in Disease Prevention, which has been able to operate as a large, interdisciplinary organisation, guided by behavioural approaches. We also discuss some setting, provider, program and client variables relevant to research and development on health promotion and disease prevention in Australia and elsewhere.

The present study investigated the effectiveness of a cognitive-behavioural approach to the management of chronic work-related upper limb pain. Clients included three females who had experienced severe upper limb pain for 7, 3.5 and 1.5 years respectively and whose condition had been labelled by medical specialists as occupational overuse syndrome. Clients commenced treatment in a sequential manner, following a staggered baseline monitoring phase in order to produce a multiple baseline design across cases. Treatment involved 8 sessions over a 4-week period, covering pain management procedures, cognitive restructuring of maladaptive cognitions, relaxation training and EMG biofeedback. All cases showed some improvement in pain, distress and interference caused by pain. In addition, changes in depression, anxiety, coping strategies and sleep disturbance were reported. Therapy gains were maintained at the 6-month follow-up assessment for 2 of the 3 cases.

Thirty men and women who regularly used minor tranquillisers and/or sedatives participated in a stress management group program, incorporating a behavioural self-management approach. They were assessed on questionnaire measures of anxiety, assertion and medication use in the first and final group sessions and at a 3-month follow-up. Data demonstrated declines in medication use during the course, which for many clients were maintained at the follow-up. These decreases were associated with decreases in anxiety levels.

This study investigated the effect of delayed reinforcement on the across-setting generalization of behaviour change. Eight children aged between 11 and 13, members of a special class at an intermediate school, served as subjects. Off-task behaviour was monitored during two classroom lessons: the contingent lesson, performance in which determined subsequent reinforcement, and the generalization lesson, in which no reinforcement contingencies were provided. Two forms of delayed reinforcement: early — delivered immediately following the setting in which the critical behaviour occurred — and late — delivered only after several other settings had been encountered — were sequentially presented in an ABCB design. Off-task behaviour decreased under both reinforcement conditions. However generalization was only evident when the late delayed reinforcement was operating. Results suggest that a temporal delay in the delivery of reinforcement is more likely to lead to generalization of behaviour change than is the delivery of reinforcement immediately following the contingent lesson.