Although low self-esteem is common in clinical populations, a cognitive conceptualization of the problem and an integrated treatment programme deriving from that conceptualization are as yet lacking. The paper proposes a cognitive model for low self-esteem, deriving from Beck's model of emotional disorder. It outlines a treatment programme which integrates ideas and methods from cognitive therapy for depression, anxiety and more recent work on schemas or core beliefs. The model and treatment are illustrated with an extended case example.

Patients' beliefs about the causes of anxiety problems have received comparatively little attention. In the present study, agoraphobic patients rated the contribution of eight factors in causing their condition. They also selected the major cause of their agoraphobia and evaluated that in relation to the elements of attributional style. The most commonly selected major cause was stress, which also attracted the highest average ratings. This was followed in frequency by disposition (being a naturally nervous person), circumstances (staying home too much) and childhood experiences. Depression was associated with stronger beliefs in the contribution of several of the causal factors and with rating the major cause as more stable and global. Anxiety was associated with a stronger belief in medical illness as a cause, and with a lower sense of controllability of the major causes. These results suggest that agoraphobic patients' views of the causes of their condition vary, and could usefully be evaluated in relation to the provision of treatment in order to modify the way treatment options are presented to the patients.

The present study examined the efficacy of eye movement desensitization and reprocessing (EMDR) in the treatment of a specific phobia. Twenty-four spider phobic subjects were randomly assigned to either (1) an EMDR group (n=8), (2) an imaginal exposure group (n=8), or (3) a control group (n=8). Both the EMDR and the imaginal exposure group underwent a one-hour treatment. The control group initially received no treatment, and waited for one hour. Next, all groups received exposure in vivo. Treatment outcome was evaluated with a standardized Behavioural Avoidance Test (BAT). No evidence was found for EMDR being more effective than imaginal exposure or waiting list control. In fact, only exposure in vivo therapy resulted in significant improvement on the BAT.

The Obsessive Compulsive Thoughts Checklist (OCTC; Bouvard, Mollard, Cottraux, & Guerin 1989) is a 28 item questionnaire. Patients rate their degree of disturbance of the past week on a 5-point scale. The validation study and factor analysis of the OCTC is presented. Three groups were compared: patients suffering from obsessive compulsive disorders (n = 122), patients suffering from panic disorder with agoraphobia (n = 61) and a control group (n = 80). The three groups were comparable in age and sex. Obsessive compulsive patients scored significantly higher than both agoraphobic patients and control subjects. Spearman rank correlations were used to compute convergent validity in a sub-group of obsessive compulsive patients (n = 96). The Obsessive Compulsive Thoughts Checklist correlated positively with the Compulsive Activity Checklist (rho =. 62; p <. 0001). The total score was also positively correlated with the Yale-Brown Obsessive Compulsive Scale (YBOCS total scale: rho =. 42; p <. 0001; YBOCS obsession scale: rho =. 40; p <. 0001; YBOCS compulsion scale: rho. 37; p =. 0002). The factor structure was studied both on the sample which included agoraphobic patients and controls (n = 141) and on the obsessive compulsive patients only (n = 122). In both analyses, three identical factors were found: – factor 1: checking/perfectionism-orderliness – factor 2: responsibility/dread of harming others – factor 3: washing/contamination. Results support the validity and the internal consistency of the Obsessive Compulsive Thoughts Checklist. The factor analysis indicates that the OCTC is a three dimensional scale, reflecting a pathological need to check, a pathological sense of responsibility and a pathological need to wash, probably due to distorted thoughts about perfectionism and orderliness, an excessive need for control and fear of contamination.

Preliminary findings are reported from a specialist unit for difficult to manage patients (those patients who have severe behavioural problems in addition to a mental illness). Staff attitudes and residents' psychiatric and social needs were assessed after the unit had been open for just over a year. The effect on residents' behaviour and symptoms over the course of that year was also evaluated. Findings showed that staff attitudes were resident orientated and that interactions between staff and residents and of staff with each other were almost always positive. These findings compared favourably with data collected on three other continuing care units in the same Trust and with data from previously published studies. The Cardinal Needs Schedule, a recent adaptation of the MRC Needs for Care Assessment Schedule, appeared to be a useful way of identifying unmet needs of the residents and gaps in service provision. Over the course of the year, behaviour in one third of the residents improved sufficiently for them to be considered suitable for potential discharge into community based accommodation. Implications of the findings for specialist units for difficult to manage patients are discussed, together with suggestions for further research.

Tinnitus is a symptom of ear disease that may cause psychological distress. We report here on the successful treatment of stress-related tinnitus in a patient with otosclerosis (an ear disease). The patient experienced stress-induced attacks during which tinnitus became unbearable. A cognitive-behavioural treatment programme of 10 sessions was given during two weeks. Results assessed at pre-and post-treatment showed decreased annoyance and increased coping with tinnitus. The attacks became less frequent and easier to handle. The results support the application of cognitive-behavioural treatment in cases with difficult tinnitus.