The hypothesis that elaboration of the phobic stimulus potentiates exposure in vivo treatment was put to the test in a clinical experiment. Forty-one female spider phobics, who applied for treatment, were randomly allocated to one of two conditions. In both conditions a 2.5 hour therapist-directed exposure treatment was given. In the elaboration condition Ss were required to attend to and describe the objective features of the spider constantly. In the non-elaboration condition the therapist tried to prevent this. A manipulation check suggested that Ss in the elaboration condition had indeed elaborated more extensively on the objective features of the spiders during exposure than Ss in the non-elaboration condition. However, Ss in the elaboration condition practised with somewhat fewer spiders than Ss in the non-elaboration condition, probably because of the time the elaboration took. Contrary to the hypothesis, elaboration did not potentiate either short-term or long-term effects of the exposure treatment. It seems superfluous to let patients elaborate on the phobic stimulus during exposure in vivo treatment: the processing of phobic stimulus information which is needed for an effective treatment seems to occur spontaneously when the patient engages in exposure in vivo exercises.

The psychometric properties of the Compulsive Activity Checklist (CAC) were examined in a sample of obsessive compulsives (OCD), anxiety disordered (AD) patients, and non-psychiatric subjects (NP). All but 9 of the 38 CAC items significantly discriminated among groups, yielding correct classification rates of 71% when OCDs were compared with ADs and 84% when OCDs were compared with normals. Internal consistency alpha was high (0.95), but nine item-total correlations for OCD subjects fell below 0.40. A 28-item abbreviated scale (CAC-R) was developed based on the above findings. Preliminary analyses of the CAC-R on a normal sample indicated that this version is an improvement over the longer version and may be a viable alternative to the 18-item French one. It appears that the original CAC can be shortened with little loss of validity. However, substantial reductions may reduce the clinical utility of an instrument assessing a disorder with such widely diverse manifestations.

Thirteen cases of Body Dysmorphic Disorder (BDD) were described. There were eight males (61.5%) and five females (38.5%) with ages ranging from 16 to 37 (mean=24.7). All patients were also diagnosed as obsessive compulsive disorder (OCD), according to DSM-III-R, with the exception of one. Patients were administered the Yale Brown Obsessive Compulsive Scale, Beck Depression Inventory, Wechsler Intelligence Scale, Over-valued Ideation Scale and MMPI. The Phenomenology of BDD, its relationship to OCD, and the patients' responses to the above tests were reported. Due to the bizarreness of the symptoms and the secretiveness of the patients, it was suggested that clinicians be thoroughly aware of the disorder and inquire as to its presence during the initial consultation. Otherwise, these patients go unnoticed and they resort to treatment from dermatologists and plastic surgeons.

Knowledge of the aetiology, epidemiology and treatment of nightmares has improved with more accurate definition of the problem. This review summarizes what is known about nightmares and their relationship with other medical and psychiatric disorders. Treatment methods are discussed, with particular reference to behavioural methods, which have become increasingly popular in recent years. Further research is suggested in order to determine the most efficient method of treating distressing nightmares.

Fisher's stepwise discriminant analysis was carried out on 10 baseline variables searching for posterior prediction of success in a sample of sixty DSM-III obsessive-compulsive patients. The patients' median score on Hamilton rating scale of depression was 19. In a controlled study they were randomized into three groups: fluvoxamine with antiexposure, fluvoxamine with exposure, or placebo with exposure. In the whole sample, five variables accounted for 76% of the correctly classified patients: avoidance score of the behavioural avoidance test, behaviour therapy expectations, fluvoxamine expectations, Beck depression inventory and rituals repetition. High avoidance score predicted 68% of the correctly classified patients in the whole sample. The discriminant function classified correctly 70% of the patients in the antiexposure with fluvoxamine group, versus 75% in the exposure with fluvoxamine group, and 85% of the patients receiving exposure with placebo (χ2, d.f.2, NS).

This paper suggests that a 24-hour perspective may be useful when considering attention and learning deficits. Sleep-wake schedules are placed within a conceptual model of arousal and attention, and it is argued that an “optimal” schedule may predict improved functioning. A synopsis of five clinical cases illustrates the application of behavioural treatment principles, designed to optimize the sleep-wake schedule. Although promising results were achieved, these must be taken as preliminary and it is hoped that further systematic study will be prompted.

Long-term inpatients with severe psychiatric illness such as chronic schizophrenia can be very socially disabled. This makes it difficult for them to move on to more independent living because they lack many of the necessary social and practical skills. Social Economy Therapy (SET) is a practical approach which aims to improve social functioning. On a hostel ward, eight long term inpatients with severe and disabling psychiatric disorders started a SET programme. After two months the social and living skills of several patients were improved and a number were discharged to other accommodation.