Recent years have witnessed the gradual emergence of a technology of nonaversive behavioural support for people with severe learning disabilities and seriously challenging behaviours. Three key aspects of these developments are reviewed, including: the functional perspective to analysis and intervention; the incorporation of the analysis and modification of setting events into behavioural practice; and the use of experimental techniques to conduct functional analyses of the contextual control of challenging behaviours. Attention is drawn to the practical implications and limitations of these developments.

Research using ambulatory monitoring and cognitive sampling procedures has revealed the importance of negatively biased cognitions in panic attacks and panic disorder. However, the normal population has never been investigated on the basis of these procedures and it is still unclear how patients deviate from them on the basis of negative cognitions and their interaction with affect and physiology. The present study investigated these issues by comparing 15 panic disorder patients with an equal number of normal controls. The results revealed that, although the pattern of reporting cognitions was similar, the two groups differed on type and content of the cognitions. In general, there were significant differences between the two groups for neutral and negative cognitions. Patients experienced high anxiety levels that were associated with cognitions of negative affect. There was a low frequency of reported panic attacks in the patients group. Possible reasons for the limited number of panic attacks are discussed.

The aim of this work was to test the comparative efficacy of four therapeutic modalities (self-exposure, self-exposure + Alprazolam, Alprazolam, and self-exposure + placebo) and also to determine the combined effects of self-exposure with Alprazolam and self-exposure with placebo in the treatment of agoraphobia without current panic. The sample consisted of 31 patients selected according to DSM-III-R criteria. A multigroup experimental design with repeated measures of assessment (pre-treatment, post-treatment and 1, 3 and 6-month follow-up) was used. The results indicated that there was a similar therapeutic improvement (in about 75% of the cases) between pre- and post-treatment in all therapeutic modalities, except for the Alprazolam group, where improvement did not take place, was rather weak or tended to fade as time passed. This improvement increased at the follow-ups in the self-exposure + placebo group, remained stable in the self-exposure group, and was irregular or fairly unpredictable in the self-exposure + Alprazolam group. There was a positive combined action between self-exposure and placebo and a negative interaction between self-exposure and Alprazolam. The highest relapse rate appeared in the therapeutic modalities where the active drug was administered. The intratreatment evolution was faster in the self-exposure group than in the others, but it tended to remain stable in the second part of the therapy. It is therefore concluded that the efficacy of self-exposure therapy may be the same if reduced to half the number of sessions. Finally, several topics that may contribute to future research in this field are commented upon.

The purpose of this investigation was to examine the separate and combined effects of cue-controlled relaxation training and “aromatherapy” as treatments for reducing speech anxiety. Thirty-six speech anxious subjects were randomly assigned to one of four conditions: cue-controlled relaxation with a word cue, cue-controlled relaxation with an aroma cue, “aromatherapy” alone, and a wait list (i.e., control) group. Prior to treatment, subjects completed the Personal Report of Confidence as a Speaker, Fear of Negative Evaluation questionnaire, S-R Inventory of Anxiousness-Speech Form, Cognitive Somatic Anxiety Questionnaire, and Multiple Affect Adjective Check List; subjects also performed a speech which was rated for behavioral signs of anxiety. The assessment protocol was repeated following treatment, and at a two-month follow-up. Thirty-two of 36 subjects (89%) provided complete data at post-treatment, and 23 of 28 treated subjects (82%) provided complete data at follow-up. Results indicated that subjects in both cue-controlled relaxation conditions decreased their speech anxiety more than did the subjects in the aromatherapy or control conditions.

Three methods of physical restraint were videotaped and presented to two groups of subjects (undergraduate students and teenagers). Two of the methods recommended restraining a person with a learning difficulty on the ground; the other method proposed seating the individual in a chair. Subjects were asked to rate the social acceptability of the procedures using the Treatment Evaluation Inventory (TEI). Both undergraduate students and teenagers rated the chair method as more acceptable. The implications of these findings for the use of physical restraint procedures were discussed.

A preliminary investigation of the content and origins of intrusive imagery and core beliefs as they occur in health anxiety is reported. The exploration of patients' images proved to be a particularly effective means of determining underlying core beliefs. Images appeared to reflect a wider range of idiosyncratic meanings than were apparent in the automatic thoughts alone. Two types of core beliefs were revealed by the images: beliefs about the self, and beliefs about death and illness and their implications, which included themes to do with abandonment and isolation. All patients had metaphysical or superstitious beliefs. It is suggested that a conjunction between the beliefs about the self and those about death and illness may contribute to individual tendencies to misinterpret bodily sensations in health anxiety.

Polydipsia is a disorder that has received little attention in the research literature. Treatment has been mainly confined to medical or pharmacological intervention. Few studies have reported the use of contingency management techniques and none have sought to encourage self-management. This study shows how such a procedure brought about a significant change in rates of water drinking in a thirty-one year old man with a mild learning disability.

Despite considerable cajoling and some good results, behavioural psychotherapists have remained predominantly intra-personal in the focus of their research. Analysis of the wider environmental determinants of the behaviours that concern them have been few, and there has been no upwards trend. This is problematic in that it fails to exploit the full scope of behaviourism, limiting practitioners and their efficiency. The present analysis concerns one kind of systems-level work, the use of data to guide a psychiatric day hospital service. Although limited in rigour and scope, it nonetheless indicates a ready and promising “generalization” of behaviour therapy from the individual to the system. The study also illustrates how the emerging behavioural assessment principle of “treatment utility” can be analysed.