A cognitive approach to auditory hallucinations that is based on the models of panic and anxiety developed by Clark (1986), Beck (1976) and Salkovskis (1991) is outlined. It is suggested that auditory hallucinations are normal phenomena, and that it is the misinterpretation of such phenomena that cause the distress and disability that are commonly seen in patients experiencing hallucinations with a diagnosis of schizophrenia. It is also proposed that these interpretations of auditory hallucinations are maintained by safety seeking behaviours (including hypervigilance). The existing literature is reviewed in relation to these hypotheses and found to be largely consistent. The clinical implications of such a model are briefly discussed and a number of testable predictions are made.

This issue contains the obituaries of two of the greats in our field, and it is tempting to regard it as the end of an era. Hans Eysenck and Joseph Wolpe were truly giants in the field, truly founding fathers of scientific cognitive-behavioural therapy. Their passing is a landmark, but clearly not the end of an era. The era that they ushered in was one in which the basis of psychopathology and treatment lay in well defined theory and rigorous, well conducted research. That philosophy has grown, developed, and has given us a scientific basis for cognitive-behavioural therapy.

I believe that it is no coincidence that both men intended, at an early age, to follow a career in the physical sciences. They had many other characteristics in common, including a firmness of purpose that served both them and the field well. Isaac Newton, writing to Robert Hooke, said of his achievements that “If I have seen further it is by standing on the shoulders of Giants”. Eysenck and Wolpe were such giants, and we should be grateful for their shoulders, and for the vision that their achievements allow us.

As I am sure you cannot have failed to notice, the Journal has taken onquite a different look, thanks to Cambridge University Press. In addition,there have been changes in the Editorial Advisory Board. We welcome some newmembers, and say farewell and thanks to some old friends. Members of the newEditorial Board are going to be very directly involved in advising theeditors and assistant editors in matters relevant to particular issues andgeographical regions.

It can be argued that an individual’s subjective experience and beliefs about a substance are important. Motives and expectancies regarding the use of alcohol and drugs are often that they are going to modify a cognitive state or help them cope with a particular situation. However, there are growing concerns in the U.S.A. and in the U.K. regarding individuals who experience psychosis and concurrently use substances. Correctly diagnosing individuals with dual presentation is said to be difficult, engagement in treatment is problematic, and medication adherence and prognosis poor. In this paper a cognitive-developmental model is proposed. I suggest that for individuals who experience psychosis and also use drugs or alcohol, the ability to identify the relationship between the substance use and the psychotic illness in terms of a case formulation/conceptualization would provide a good starting point for developing strategies and interventions that are most likely to succeed in treatment. Such an approach would explicitly address key cognitions. Unless the dysfunctional substance-related beliefs are addressed, adherence to medication and engagement with treatment services will be hindered and the possibility of relapsing to problematic substance use and acute psychosis remains. A cognitive treatment component, to target these beliefs, based on the cognitive model of substance misuse and the motivational interviewing approach will also be briefly outlined.

Psychological treatment that reduces anxiety has been found to be beneficial to benzodiazepine withdrawal. High drop-out and relapse rates, however, have also been reported. They might be due to a heightened anxiety level maintaining the drug-taking habit or to the addictive potency of the drug, which is not addressed by the intervention strategies. In the present study, initial assessment data were compared among treatment refusers, drop-outs and completers – successful as well as unsuccessful ones – of a psychological treatment programme in support of benzodiazepine withdrawal. Treatment refusers showed a more negative current mood state than those consenting to treatment. Internal locus of control was predictive of premature termination and unsuccessful completion of the treatment trial. Neither medication-related variables nor anxiety or depression were found to influence the success of treatment. Perceived control over medication intake is thought to reduce compliance with the treatment regimen – a pattern that may be consistent with the addiction hypothesis.

Recent “Power Therapies” claim near miraculous cures but fare less well under controlled testing. These developments recall for cognitive behavior therapists the history of past “cures” that temporarily induced high levels of expectancies, but failed the test of time.

Previous research on vulnerability to Post-Traumatic Stress Disorder (PTSD) has been restricted by the absence of prospective studies that measure individual differences prior to traumatization. This study investigated the predictors of analogue post-traumatic intrusive cognitions using a fully prospective design. Non-patient participants completed a range of predictor measures before being exposed to a film about a traumatic fire. Film-induced changes in negative mood were also assessed. Subsequent intrusions were measured both within the experimental session and for a further seven days. The hypothesized predictors were: neuroticism, trait anxiety, extraversion, depression, a general tendency to suppress unpleasant thoughts, beliefs about being “at risk” from fire, mental imagery, self-rated proneness to intrusions and negative mood changes. The results showed that intrusions were predicted by film-induced increases in negative mood, thought suppression tendencies, beliefs about vulnerability to fire and self-rated proneness to intrusive cognitions. The findings are discussed in relation to the literature on thought suppression and cognitive processes in PTSD.

A recent cognitive model of social phobia (Clark & Wells, 1995) suggested that negative self-images may play an important role in maintaining the disorder. To investigate this suggestion, 30 social phobics and 30 non-patient controls were given a semi-structured interview which focused on spontaneously occurring images. Social phobics were significantly more likely than controls to report experiencing images when anxious in social situations. In addition, social phobics’ images were significantly more negative and significantly more likely to involve seeing oneself from an observer’s perspective. Implications of these findings for the understanding and cognitive treatment of social phobia are discussed.

Recent discussion has emphasized the importance of assessments of clinical significance of outcome in treatment outcome studies. Several methods exist to assess clinical significance, one of which is the use of global ratings of outcome. This study reports the use of such measures in a treatment outcome study investigating pharmacological and psychological treatments for panic disorder and agoraphobia in primary care. Outcome is reported in terms of global ratings of symptom severity and of change in symptoms following treatment, completed by the psychologist, referring General Practitioners (GPs) and patients. Treatments involving cognitive behaviour therapy showed greater efficacy than those employing pharmacological treatments alone. Considerable agreement was demonstrated between psychologist and patient ratings. Such agreement was much less obvious for ratings completed by referring GPs. Possible reasons for this are advanced.

This study investigates whether large-scale, day-long stress management workshops open to the general public can work as well as small, weekly groups run for referred clients. It is suggested that the self-referral route may enable some people who might otherwise have been ‘‘filtered out’’ from the traditional health services to get help for their stress-related problems. Analysis showed that the large-scale format was just as effective with a more distressed subgroup as was the small weekly format for formally referred clients, which suggests that the effectiveness of this approach is not only related to a restricted client group. It would appear that the low drop-out rate, the effectiveness of the workshops and the severity of problem handled within this format indicates potential value in this type of approach.

Childhood phobias are complexly determined but responsive to behavioral interventions. This review focuses on emotive imagery, a variant of systematic desensitization developed specifically for use in treatment of children’s excessive fears. Although emotive imagery appears to be a useful treatment procedure, further research is needed before it could be considered as having “well-established” empirical status. Several other important methodological and theoretical issues are emphasized.

A substantial literature now exists that indicates that cognitive-behaviour therapies are effective for a wide range of psychological problems (See Hawton, Salkovskis, Kirk, & Clark, 1989). However, it is only very recently that cognitive-behaviour therapists have considered people with learning disabilities as suitable clients for this particular approach. The present paper describes some of the challenges that are encountered when applying cognitive-behaviour therapy to this client group.

The relative efficacy of cognitive restructuring and interoceptive exposure procedures for the treatment of panic disorder, as well as the differential effects of the order of these interventions, was studied. Eighteen clients with panic disorder were seen for four sessions of exposure therapy and four sessions of cognitive therapy in a crossover design study. Half of the participants received exposure therapy followed by cognitive therapy and for half the order was reversed. There was a 1-month follow-up period between the two interventions and after the second intervention. Questionnaire measures and independent clinician ratings were used to assess outcome. Participants expected greater benefit from cognitive therapy, but tended to improve to a similar degree with either intervention. The order in which treatments were presented did not influence outcome. Participants tended to improve with the first intervention and maintain improvement across the follow-up periods and subsequent intervention. Several methodological limitations qualify the conclusions that can be drawn from this study. These limitations, as well as some conceptual and methodological challenges of conducting this type of research, are discussed.

Morbid jealousy is a potentially disruptive condition that has received little attention. A cognitive-behavioural formulation of morbid jealousy proposes that such individuals possess schema in which there is a perceived threat of loss of their sexual partner. An attentional bias in morbid jealousy was investigated by using a dichotic listening task and the modified Stroop test. Twenty subjects who had met criterion for morbid jealousy were compared with 20 control subjects. In the dichotic listening task, word pairs were presented to each ear simultaneously, and subjects shadowed one channel while identifying target words. Ten percent of the words presented to the non-attended channel were target words, of which half were jealousy-related and half were not. Subjects were not told that the target words were only presented in the unattended channel. In the modified Stroop test, subjects had to name the colour of a series of Os, colour words, emotional words, control neutral words and jealousy-related words. As predicted, jealous subjects showed a superior performance in detecting jealousy-related stimuli in the dichotic listening task and an impaired performance in the colour naming of jealousy-related stimuli in the modified Stroop test, compared to the control subjects and the control conditions. The results of this study add support to the formulation that morbid jealousy involves an attentional bias towards jealousy-related information and this may have clinical implications.

Research aimed at identifying genes contributing to the aetiology of psychological disorders is in progress. This raises the possibility that genetic testing for such genes might become available. In this paper the possible psychological consequences of genetic testing for psychological disorders are examined. It is proposed that genetic testing may cause psychological and behavioural reactions that actually increase the person’s risk of developing a psychological disorder or may maintain existing problems. It is also suggested that cognitive-behavioural models may be able to aid prediction of some of the likely consequences of testing and identify people who are likely to react in particularly negative ways to news of their genetic risk. If genetic tests for psychological disorders are developed, it is important that research is carried out into the psychological and behavioural effects of testing and ways of minimizing adverse effects, before such tests become widely available.

While treatments for Generalized Anxiety Disorder have considerably improved recently, they remain less effective than similar treatments for other anxiety disorders. This paper reports on a comparative outcome study of a large group didactic therapy specifically designed to teach patients to “become their own therapists” in an attempt to counter the relapse problems commonly associated with this condition. The data suggest that improvements noted at six month follow-up are maintained at two years. Suggestions are forwarded to explain the lack of differential responding found among different therapy approaches.

The thorny issue of inappropriate authorship is a well recognized problem in research (Epstein, 1993). Recent editorials and articles in the British Medical Journal (BMJ), Lancet and Journal of American Medical Association (JAMA) have raised its profile amongst our medical colleagues. The current authors feel that clinical psychologists, nurses and other mental health professionals need to be more aware of the complexities of the area. Hence this paper intends to clarify the major concerns regarding proper accreditation and gives some recommendations and guidelines.

The French version of the Social Interaction Self-Statement Test (SISST) was studied in 95 social phobia and 87 non-clinical subjects. Total scores on both positive and negative scales significantly discriminated social phobics from non-clinical control subjects. Social phobics had higher scores than controls on negative statements and lower scores on positive statements. The positive and negative subscales of the SISST for social phobic patients were correlated with anxiety, depression and avoidant behaviours. The negative subscale was significantly sensitive to change in patients with social phobia receiving cognitive behavioural therapy. Our findings showed good convergent and discriminant validity of the SISST and the sensitivity of the negative sub-scale to improvement after cognitive behavioural therapy.

In order to test the efficacy of a self-help anxiety management package, 62 anxiety disorder patients were randomly allocated to one of three conditions. “Stress-pac” patients were given a self-help package, “Advice Only” patients were offered verbal advice on ways of coping. Patients in both conditions were seen on one occasion shortly after referral for assessment and management advice. They were then placed back on the waiting list for a three-month period. Patients in the “No Intervention” condition also completed measures during this time. They were formally assessed at the end of this period. All patients were then followed through therapy. Results from a previous paper clearly indicated the superiority of the Stresspac condition at all data points up to one year follow-up. This paper looks at three-year follow-up and, while finding generally good outcome across conditions, finds further evidence of the superiority of the Stresspac condition on a range of measures.

Social psychological models of reasoned action, and behavioural models of verbal behaviour, predict that caregiver beliefs and attributions partially determine their responses to challenging behaviours. The present study examined the relationship between special educators’ causal attributions and the underlying function of challenging behaviours in children with learning disabilities. Sixty special school staff were presented with two questionnaire vignettes describing attention seeking and task avoidance behaviour. They were then asked to identify the likely causes of the behaviours. Only a small proportion of participants made accurate causal attributions about the two examples of challenging behaviour. In addition, staff experience had little effect on the accuracy of attributions. Implications for future research, for staff training, and analysis of challenging behaviours are discussed.