Fordyce's (1976) analysis of pain behaviour provides a framework for evaluating the extent to which empirical studies of the operant treatment of chronic pain have adhered to appropriate behaviour–analytic principles. These are the identification of target behaviours and their reinforcing contingencies, the specification of individualised reinforcers to be used in treatment, and the generalisation and maintenance of treatment effects. Twenty-five studies that reported having used an operant approach in the management of chronic pain problems were reviewed. With one exception, none of the studies reported sufficient data to indicate the degree of adherence to behaviour–analytic principles. Until more such data are reported, it will continue to be difficult to determine clearly those factors that contribute to the efficacy of operant approaches to chronic pain management.

This paper investigates two contrasting family therapy approaches in the treatment of alcoholism. Twelve families were randomly assigned to either a symptom-focused or systems-focused treatment. Measures of marital satisfaction, family satisfaction and alcohol dependency were recorded before treatment commenced, after treatment and at a six-month follow up. The results showed that both treatments were equally effective in producing desired change, thus offering clinicians increased choice in the range of effective family interventions.

If behaviour therapy is to remain viable and relevant, it needs to address key problems in the settings in which they arise. One major problem facing behaviour therapists is that of procuring institutional innovation. This study illustrates the successful application of an “organizational behaviour management” (OBM) approach within a psychiatric day hospital. The central issues of measuring and manipulating important system variables, and of relating these to clinical outcomes, are addressed by concurrent process and outcome evaluations with nurses and patients. It is concluded that OBM represents a promising and effective extension of the behaviour therapists' skills.

In a previous study (Felce, de Kock and Repp, 1986), appropriate client activity was found to be considerably higher in two community homes for severely and profoundly mentally handicapped adults than in a number of institutions. Client activity was also shown to be related to the extent of staff interaction. The method of this study was replicated in a two-year follow-up to investigate whether these desirable levels of staff interaction and client activity were maintained. Client engagement in appropriate activity remained similar for five subjects but had fallen slightly for a further five. The duration of instruction given to the majority of subjects by staff had declined but so too, for a variety of reasons, had staff–client ratios. Overall, the follow-up data give a general impression of the maintenance of client activity with some subjects engaging with greater independence. However, interpretation is dependent on the role that staff–client ratio may play in determining staff performance and in particular their level of interaction with clients.

A severe phobia of snakes was treated by exposure in imagination, no in vivo exposure taking place. Imaginal exposure homework was given with the aid of audio-tapes of the treatment sessions. After treatment, in a behavioural test, the client experienced rapid habituation of anxiety to handling a live snake. The total amount of time taken for the treatment was similar to the time taken in treating other small animal phobics by in vivo exposure alone. It is suggested that for specific phobics the use of imaginal rehearsal prior to in vivo exposure may optimise the conditions under which in vivo exposure takes places and require no more of the therapist's time than the usual in vivo methods.

The successful resolution of a problem of school phobia using self-management strategies is reported. The clinical report is prefaced by the observation that differences of emphasis are apparent when authorative reviews of the field of self-management are considered—and the conclusion drawn is that the successful outcome could be used to lend support to Kanfer's two-stage model of self-regulation. The client, Anne, was a pupil in the first year of comprehensive schooling. She attended school on only four days during the first term. Problem analyses in terms of operant and classical learning theories are described, and intervention strategies were generated which were accommodated within Kanfer's two-stage model of self regulation. Anne self-recorded school attendance, lesson attendance and self-confidence. School attendance was immediately achieved and progress towards full lesson attendance was made over a seven-week period. Affective state (self-confidence) as assessed by self-report was observed to increase as lesson attendance improved but a temporal lag was observed. The report concludes with some observations of a theoretical nature and justification for the intervention to warrant the descriptor “self-management”.

The effect of subvocalisation on reading speed and comprehension is briefly reviewed. Reading speed is slowed by subvocalisation but comprehension and retention of complex material is improved. In this single case study the activities of the laryngeal and mylohyoid muscles were recorded during reading and other activities. Through electromyographic biofeedback the patient learnt to reduce muscle tension and to discontinue the long term habit of subvocalisation.