The aim of the study was to develop a cognitive behavioural treatment model for medically unexplained physical symptoms and assess its feasibility and effect in a small sample of patients. This study was the first step in the realization of a randomized controlled trial. The study population consisted of consecutive patients presenting at a general medical outpatient clinic, whose symptoms could not be explained by objective abnormal findings. The treatment was based on a general model of the disorder, consisting of the physical symptoms, the patient's attribution and perceived control and the cognitive, behavioural, physical and social consequences. It incorporated record keeping concerning physical symptoms and emotions, identification of cognitions about the symptoms, challenging dysfunctional thoughts and behavioural experiments. At 6–months follow-up, four of the five treated patients were improved with regard to frequency and intensity of the symptoms, psychological distress and functional impairment. The improvement was sustained at 1–year follow-up.

Testing a variant of Wegner's (1989) “thought suppression” paradigm, we had subjects identify a personally-relevant negative thought that had been troubling them recently. Subjects were then randomly assigned either to a negative target thought group or to a neutral target thought (“white bear”) group, and randomly assigned either to an initial suppression condition (followed by a free expression period) or an initial free expression condition (followed by a suppression period). The results revealed that subjects in the neutral thought group experienced a decline in thoughts about white bears throughout the course of the experiment, whereas subjects asked first to suppress a personally relevant negative thought experienced nearly a three-fold increase in its frequency of occurrence when later given permission to express it. These findings suggest that negatively valent thoughts may respond differently than neutral thoughts following attempts to suppress them.

Forty-three children with recurrent abdominal pain who had received treatment from a paediatric gastroenterology clinic were reassessed 6 and 12 months after initial presentation. Measures of children's pain included a pain diary (PD) which measured pain intensity, a parent observation record (POR) which assessed pain behaviour and a structured interview to assess the degree to which pain interferes with the child's activities. Pretreatment measures of the child's history of pain, coping strategies in dealing with pain, and their mother's caregiving strategies were examined as predictors of two indices of clinical improvement: the extent of change in pain on the child's pain diary from pre-test to 6 months follow-up, and the degree of interference to the child's activities. All children had shown significant improvement in the level of pain at follow up, with 74.4% being pain free at 12 month follow-up on the PD and 83.7% being pain free on the POR. The amount of change they showed varied, with some showing residual impairment even though they were significantly improved. Regression analyses showed that children with greatest reductions on the child's pain diary at the 6 month follow-up were those with a stress-related mode of onset, whose mothers used more adaptive caregiving strategies, and who received cognitive behavioural family intervention. There was also a non significant trend for younger children to fare better. These data suggest the importance of early diagnosis and routinely assessing parental caregiving behaviour and beliefs about the origins of pain in planning treatment for children with RAP.

The range of areas where cognitive-behavioural treatment (CBT) is applied has been considerably extended over the previous decade. This paper describes the application of CBT in the German health care system as typified by a random sample of 1,344 cases. Content analysis was used, and indicates a generally appropriate pattern of treatment strategy. Cognitive components were more prominent than behavioural ones in the description of treatments used.

The aim of this paper was to test the comparative effectiveness of three therapeutic modalities: a) individual stimulus control and exposure with response prevention; b) group cognitive restructuring; and c) a+b in the treatment of pathological gambling with slot machines. An additional waiting-list group was used to evaluate the spontaneous evolution of the non-treated gamblers. The sample consisted of 64 patients selected according to DSM-III-R criteria. A multigroup experimental design with repeated measures (pretreatment, posttreatment and 1, 3, 6 and 12-month follow-up) was used. Most treated patients gave up gambling as well as improved, albeit more slowly, in family/social and psychological functioning. The success rate was higher in the individual treatment compared both to group and combined treatment. There was also an improvement in gambling in the control group between the pretreatment and the 6–month follow-up and there was no difference between the combined treatment and control group. Individual stimulus control and exposure with response prevention appears to be a cost-effective therapy for pathological gambling. Implications of this study for clinical practice and future research in this field are discussed.

Cognitive behavioural therapy has been shown to be effective in reducing anxiety and depression in cancer patients when provided within the context of individual sessions. We describe the application of a cognitive behavioural model to a group therapy context. This represents a novel approach to the psychological treatment of cancer patients. Fourteen breast cancer patients attending the Royal Marsden Hospital were included in an assessment of treatment outcome pre-and post-group therapy. Outcome was assessed using the Hospital Anxiety and Depression (HAD) Scale and a study-specific visual analog measure relating to perceived efficacy of the therapeutic techniques. Rationale and organization of group therapy is described along with the preliminary pilot study results.

An eight year old boy who had prolonged faecal incontinence associated with surgery in infancy for Hirschsprung's disease was assessed and given biofeedback training for the purpose of achieving anal sphincter control. A computer-based apparatus was constructed to give feedback in the form of a graph and column of light. The child learned to produce tracings on the graph by contracting a small saline-filled balloon positioned at the anal sphincter. The child achieved voluntary defaecation, and eliminated soiling during follow-up periods of twelve and twenty four months.