Evidence is now accumulating for cognitive therapy as a promising treatment for depression. However, there is as yet little indication as to how it achieves its effects. The paper addresses this issue as it relates to the immediate impact of therapy, the achievement of change over the course of treatment as a whole, and the maintenance of improvement and prevention of relapse.

Self-controlled relaxation training was combined with assertion training to treat a 22-year-old woman with a 2-year history of chronic headaches following a traumatic injury to her head and neck. There was a substantial drop in the frequency of headaches and medication use with the introduction of both components of treatment. Gains were maintained at a 6-month follow-up. The case is presented in the context of a general treatment plan for modification of traumatic headaches. The plan combines a focus on both antecedent (i.e. environmental stress) and consequent (i.e. pain behavior reinforcers) events as possible factors influencing chronic post-traumatic head pain.

Twenty-eight young adult out-patients with social interaction difficulties were assessed in an attempt to measure the three variables of social performance, social anxiety and self-esteem. A non-clinical comparison group comprising 32 subjects from a university subject panel were assessed on the same measures. There were significant differences in the patient and non-clinical group on anxiety and esteem, however, some patients scored well within the range of the non-clinical group and had adequate social performance. The patient group was characterized by high social anxiety which was more often related to low self-esteem than adequacy of social performance. We concluded that interaction difficulties are multiply determined and social performance, social anxiety and self-esteem are potentially independent variables. The implications of this for therapy were discussed.

To determine the role played by peripheral autonomic arousal in reducing avoidance behavior, 16 spider phobics were randomly assigned in a double blind fashion to either a propranolol (a drug which blocks beta-adrenergic activity) or to a placebo group. Subjects in the propranolol group performed significantly better than those given placebo although the magnitude of the effect was small. All subjects later received 90 min of participant modeling. They performed significantly better with participant modeling and there were no differences between the groups in their final performance. Implications of the data for theories of fear and avoidance behavior are discussed.

Recent years have seen a growing concern in the psychometric properties of behavioural assessment procedures. The present study addresses itself to the question of the possible reactivity of the behavioural assessment of fear, a situation predicted both by the experimental extinction and incubation models.

In a single case study it was found that a 50% reduction in self-reported fear was associated with the behavioural assessment, though there was no evidence of a reduction of fear associated with “verbal therapy”. It is suggested that: (i) behavioural assessments of fear are reactive; (ii) that they produce a reduction in fear; and (iii) that this is consistent with an extinction model.

Motivational interviewing is an approach based upon principles of experimental social psychology, applying processes such as attribution, cognitive dissonance, and self-efficacy. Motivation is conceptualized not as a personality trait but as an interpersonal process. The model deemphasizes labeling and places heavy emphasis on individual responsibility and internal attribution of change. Cognitive dissonance is created by contrasting the ongoing problem behavior with salient awareness of the behavior's negative consequences. Empathic processes from the methods of Carl Rogers, social psychological principles of motivation, and objective assessment feedback are employed to channel this dissonance toward a behavior change solution, avoiding the “short circuits” of low self-esteem, low self-efficacy, and denial. This motivational process is understood within a larger developmental model of change in which contemplation and determination are important early steps which can be influenced by therapist interventions. A schematic diagram of the motivational process and a six-step sequence for implementing motivational interviewing are suggested.

The successful treatment of a client with a handicapping fear of other people vomiting is described. This involved exposure to “vomiting”, using a simulation procedure. It is suggested that the appropriate stimulus in such cases may be someone vomiting rather than vomit itself.

A pilot controlled study was designed to evaluate the efficacy of the thought-stopping technique (T.S.) as a treatment for persecutory delusions and auditory hallucinations with chronic schizophrenics already treated with neuroleptics and to compare this combination with patients only treated with antipsychotic drugs. Medication was standardized for each patient and psychological measurements were recorded before and after treatment and during a 6-month follow-up. Results show significant differences in favor of the T.S. group mainly after treatment. Although T.S. was beneficial for chronic psychotics, other studies should be conducted with patients whose illness would be less severe and less chronic. The length of treatment as well as the cues that would serve to stop delusions and hallucinations also merit further investigation.