This investigation was designed to evaluate the utility of a behaviour therapy programme provided on an outpatient basis for the management of chronic pain. Twenty-eight chronic pain patients were randomly assigned to one of three groups. The first group served as a waiting-list control and had minimal contact with the clinic during the study, while the second group received the regular treatment regime provided by the rehabilitation clinic. The behaviour therapy group also received some of the regular treatment techniques offered by the clinic, but in addition, these patients were given: (1) training in applied relaxation (coping) to control the pain, and (2) an operant activities programme to increase relevant activities at home. Results indicated that the behaviour therapy group had significantly greater reductions in pain than the other two groups, and moreover, the behaviour therapy group had the best results for variables of sleep, activity and medication levels. These findings suggest that applied relaxation and an activities training programme may be valuable tools for the remediation of chronic pain.

Forty-five overweight children aged 6 to 13 were randomly assigned to one of four conditions: a behavioural programme occurring on a rapid schedule, the same behavioural programme presented on a schedule of gradually decreasing frequency, a non-specific control procedure and a waiting list control group. Experimental procedures required subjects to attend eight sessions, accompanied by a parent. The behavioural approach was found to lead to significantly greater reductions in obese status as measured by absolute weight loss and percentage overweight for age, sex and height, in comparison to both the non-specific control procedure and the waiting list group during treatment. This difference was maintained at the 11 week follow-up. Comparison between the rapid and gradual scheduling of behavioural sessions revealed little difference in outcome in the long term, other than effects which reflected differences in duration since the onset of treatment. Skinfold measures were found to be less sensitive to change, with differences between groups being evident only in the longer term assessments.

To date clinical psychology research in primary health care has not taken sufficient account of the specific medical learning history of psychosomatic/anxiety patients and of the need to modify this learning process in therapy. In this pilot study a clinical judgement method is used to identify a group of primary care patients with physical symptoms where the general practitioner considers psychological factors highly relevant. Brief behavioural psychotherapy is defined and offered to those patients in order to provide effective approaches to their symptoms.

As a result different patient groups emerge: those who do not attend for their initial interview, those who attend only for their initial interview and those who attend for further sessions. These groups differ in general practice consultation rates prior to the intervention, and their consultation rates change differently following the intervention. The regular therapy attenders also differ from the “interview only” patients in terms of chronicity and degree of depressive symptoms. Significant symptomatic improvement was achieved for the therapy group. Further research is needed to identify the different groups of psychosomatic primary health care patients.

This paper illustrates the use of a single case design and analysis based upon assignment rather than sampling theory in a series of case studies of young and handicapped children with sleeping difficulties. The strengths and limitations of the design are discussed.

Staff training placements for psychologists and social workers at the Anson House Preschool Project, a service-research facility at the Hester Adrian Research Centre are described. The placements involved working in an interdisciplinary team with an integrated group of handicapped and non-handicapped children. Part of the training included the acquisition of behavioural skills which were taught through a microteaching model with the emphasis on the enactive mode of learning. The effectiveness of this training was evaluated through written and practical procedures. Significant improvements were found on all evaluation procedures from pre-test to post-test. However, trainees who scored highly on one procedure did not necessarily show high scores on the other procedures relative to the other trainees, except on post-test scores. A ceiling effect was noted on the practical procedures, the better the trainees scored initially the smaller the percentage gain made from pre-test to post-test. No significant differences emerged between social workers and psychologists.

The enuresis alarm is a very successful method of treating nocturnal enuresis. Nevertheless many children drop-out of treatment and many relapse once dryness has been achieved. This paper examines the relationship between 30 variables, measured during the pre-treatment assessment of 75 enuretic children, and treatment outcome (success, failure, drop-out and relapse). Treatment was either by the enuresis alarm alone or the enuresis alarm preceded by four weeks of retention control training. Two features of diurnal bladder control (frequency and urgency) were related to failure in treatment and two factors reflecting parental intolerance to wetting (early toilet training and parental urging to use the toilet) were related to treatment drop-out.

Behavioural ecology is a perspective within applied behaviour analysis which focuses on the complex relationship between interacting parts of a system, and particularly on the untargeted “side-effects” of interventions. This article considers two ecological effects of a large-scale nurse training venture in which 65 qualified psychiatric nurses received a one week in-service training in behaviour therapy. The effects of this training on two untargeted parameters, the nurses' clinical case notes (response generalization; N = 73) and ward teaching (generalization across subjects; N = 50) were evaluated via a combination of time-series and control group designs. The results indicated that the case notes became significantly more descriptive and less subjective, and that the learners developed significantly superior skills and knowledge in behaviour therapy as a consequence of the in-service training. These findings are discussed in terms of nurse training and behavioural ecology. The implication is that evaluations to date have generally been ecologically invalid, and that research on this topic would benefit from a more complex, naturalistic perspective.

One of the major problems facing behaviour therapy has been the relative lack of success in bringing about lasting change in complex environments. The difficulty in assessing and understanding these failures may well be due to an unnecessarily narrow view of change in terms of small units of behaviour and short time-scales. In contrast, if one takes a “setting events” perspective, this might generate more explanatory hypotheses by focusing on larger behavioural units and longer time-scales. This exploratory study adopted such a perspective in order to consider staff opinions about the maintenance and generalization of an innovative behavioural programme in psychiatric rehabilitation. The results of a structured interview with a small group (n = 11) of multidisciplinary staff indicated the potential value of this perspective: factors traditionally regarded as obstructing innovation (such as not enough time, staff or facilities) were not in fact seen as problematic. On the contrary, factors which were more readily manipulable (such as feedback, nursing officer support and in-service training) were regarded as facilitating planned change. The implications of these findings and this perspective for sustained organizational development are discussed.

There is empirical evidence demonstrating the effectiveness of behavioural marital therapy. However the issues of predicting outcome and the responsiveness of particular marital problems to behavioural treatments, while crucial, have been largely ignored. Forty-five couples requesting therapy were consecutively assigned to either conjoint treatment, couples group treatment or treatment of one partner alone to ascertain whether a screening profile could be developed that would predict treatment outcome. In addition, the presenting target problems were analysed to investigate their responsiveness to treatment. The effects of the treatment were evaluated using measures of marital satisfaction, sexual satisfaction, presenting marital target problems and by an independent assessor. Using demographic and treatment variables as regressors, the analyses revealed that the coefficients were not on the whole statistically significant in predicting outcome. The trend analysis of target problems showed that conjoint treatment produced a more rapid rate of change compared to the other treatments. In addition, particular marital problems failed to respond to the treatment suggesting that the behavioural approach may require modification in the treatment of these problems.

In order to test its effect on compliance with recommended practice of relaxation training, patients in anxiety management training groups were provided with additional information about the procedure and its rationale. After an introductory training session all subjects were provided with audiotaped relaxation instructions to use for three weeks until the second group meeting. Additional information was provided either as an audiotaped message at the end of the relaxation instructions (“Message”) or as a printed leaflet (“Leaflet”). In a 2 × 2 factorial experiment 32 subjects were randomly assigned to one of four conditions: (1) Message, (2) Leaflet, (3) Message and Leaflet, (4) Basic Programme alone. Neither manipulation had an effect on self-reported frequency of practice during the three weeks (which was high), but both increased subjects' knowledge of the treatment and also their satisfaction with it. Subjects receiving the message were significantly less likely to drop out of treatment during the remainder of the 16-weeks group programme. Compliance was predicted by subjects' perceptions of the severity of their condition but not by their knowledge, satisfaction or state anxiety.

This study applied a number of behaviour modification strategies in an attempt to reduce the level of disruptive classroom behaviour, and to programme for generalization of treatment effects across time and settings. Eight disruptive students represented either the Control, the Experimenter-selected Objects, or the Self-selected Activities Group. During intervention phases subjects in the Experimenter-selected Objects Group received school related material reinforcers for low levels of disruptive behaviour. The Self-selected Activities Group experienced a more complex set of conditions: partial self-determination of natural reinforcers, self-evaluation and recording, bonuses, group contingencies, individual progress graphs, eventual transition from continuous to intermittent reinforcement, and inclusion of common stimuli in the training and generalization settings. The results indicated that both reinforcement programmes dramatically reduced disruptive behaviour. The less complex package employed with the Experimenter-selected Objects Group, however, yielded significantly better generalization of treatment effects across time in the training setting, as well as across settings during the intervention phases. Additionally, this group showed significantly better maintenance of generalization across settings following programme termination.

Forty primary nocturnally enuretic children were randomly assigned to one of four experimental conditions over a ten week period. These were (a) standard Pad-and-Buzzer Training (PBT), (b) Stop—Start Training (SST), involving practice in interrupting the flow of urine during micturition, (c) Dry Bed Training (DBT) and (d) Waiting List Control (WLC). Numbers of dry nights were assessed during a 14 days pre-treatment baseline period, and again during 14 days at the end of treatment and at 12 weeks follow-up. At the end of treatment the proportions of subjects in each condition achieving 14 consecutive dry nights were: PBT 44.4%, SST 16.6%, DBT 50% and WLC 0%. Each of the three treatments produced more dry nights than the WLC, but did not significantly differ from one another. The results were discussed in terms of their generalizability and in the context of superior results previously reported for DBT.

Methods of evaluating training courses in behaviour modification for staff working in mental handicap are briefly reviewed. Insufficient attention seems to have been paid to changes in staff behaviour following training. A widely used training package—the E.D.Y. Course—was investigated using a non-equivalent control group design. Four special school teachers were given E.D.Y. training and compared with four control teachers pretraining, post-training and at a fourteen month follow-up. Results indicated that experimental teachers changed their behaviour following training in the expected direction and maintained this change at follow-up. Control group teachers showed no behavioural change from occasion to occasion and scored significantly lower than the experimental group on the dependent variable on each occasion. The results are discussed in terms of the effectiveness of the package and the maintenance and generalization of skills.

Eleven residential care staff working in a secure unit with disruptive or delinquent youths were trained to use a variety of behavioural methods and teaching-parent interaction skills as outlined by the Achievement Place Programme. Three months following a 1-month full-time training programme, staff were observed in the work environment using a behaviour coding system. An attempt was made to identify which care staff behaviours influenced the clients' and colleagues' judgements about staff behaviour towards the youths. Staff who frequently asked for information from the youths were rated more positively by both colleagues and youths. The use of praise influenced the youths' judgements of care staff, whereas the expression of affection towards the youths influenced staff judgements of colleagues. Other aspects of conversation or teaching interaction skills did not correlate with boys' or colleagues' judgements of the care staff. Responses such as checking for understanding, requesting practice, giving prompts and feedback were rarely used by care staff. The study provides evidence of social validity for certain staff behaviours as influencing judgements made by clients and colleagues.

This article presents an examination of 17 empirical studies of the in-service training of psychiatric and mental handicap nurses in behaviour therapy. Particular attention is given to subject characteristics, training methods, course content and evaluation. It is concluded that the integrity of both independent and dependent variables in this literature is suspect, and that it may therefore be premature to consider abandoning nurse training as a vehicle of institutional change. In contrast, what is needed are more systematic investigations, especially those which relate training interventions to institutional constraints, since both variables appear to be necessary conditions for successful innovations in patient care.

Several previous studies have reported that cognitive/behavioural treatments have been relatively ineffective for chronic, drug-resistant depressed patients. In the present report, six chronic, drug-resistant depressed patients were treated with an integrated program consisting of cognitive/behavioural treatment, pharmacotherapy, and short term hospitalization. The obtained improvement rates were substantially better than previous studies. Potential explanations for these findings are discussed.

This is a report of a 29-year-old man who presented with (1) multiple phobias, including fears of eating with others, blood and injury, and fainting in crowds; (2) ejaculatory incompetence; and (3) grief unresolved five years after his first wife's death, causing distress and avoidance of grief cues. As he declined an offer of behavioural treatment for the grief, the intention of the case design was to measure changes in grief-related distress and avoidance, but not treat it. However, exposure in vivo for the largely non-grief-related phobias involved inadvertent exposure to cues for grief and the man initiated some self-directed exposure to cues for grief. Measures indicated reduction in both phobic and some grief-related symptomatology. Mechanisms possibly accounting for these changes, and difficulties encountered in trying to treat this phobia while leaving grief untreated, are discussed. It is suggested that under certain circumstances, grief pathology may reduce during behavioural treatment for related phobic problems.

The effectiveness of brief treatment via assertiveness training and exposure in vivo was evaluated in a crossover study of eight agoraphobics. Exposure treatment brought short-term benefit as assessed by phobia questionnaires and a depression inventory, but assertiveness training did not. Conversely, assertiveness training produced short-term improvements as measured by an assertiveness inventory, while exposure treatment did not. Both treatments were relevant to the problems of our client sample, but they had specific effects on measures closely related to each treatment's target, consistent with the results of a similar recent study by Emmelkamp et al. (1983). At six-month follow-up assessment, phobia questionnaire scores were unchanged from post-treatment assessment, but assertion scores had reverted to pre-treatment levels. In addition, five untreated agoraphobics completed phobia questionnaires on two occasions, six months apart. In a quasi-experiment, their scores on the two occasions were compared with treated clients' pre- and post-treatment scores. Treated clients showed significantly greater improvement, demonstrating the sensitivity of the questionnaires to treatment effects.

Two theories have been advanced to explain the paradoxical increase in fear and avoidance seen after short unreinforced exposures to phobic stimuli. Incubation theory (Eysenck, 1968) and sensitization theory (Watts, 1971) are similar with regard to the conditions specified for enhancement of such responses. However, an incubated response is seen as specific to the CS in question, whereas sensitized responsiveness is a more generalized process. Subjects were either exposed or not exposed to a feared stimulus (cockroaches), and were then administered generalization tests to the same stimulus or to a non-feared stimulus (toad). Measures of subjective anxiety, behavioural avoidance and physiological activity were taken. No evidence was found for the enhancement phenomenon to either phobic material or non-feared material. The phenomenon does not appear to be a reliable one.