A case of blood-injury phobia complicated by fainting is described. Measures of cerebral blood flow velocity (CBFV) and heart rate (HR) indicated that phobic exposure reliably precipitated a marked drop in CBFV, simultaneous with an increase in HR and onset of dizziness. It is suggested that hyperventilation was a factor exacerbating fainting in this case. Muscle tensing produced small increases in cerebral blood flow velocity but these were not of sufficient magnitude to prevent onset of dizziness. The patient improved with treatment involving graded exposure, respiratory control and muscle tensing. At seven months follow-up the patient maintained improvements in anxiety and avoidance but again became faint during exposure.

This study represents an attempt to evaluate Barkham and Shapiro's (1988) two-plus-one model of brief psychotherapy with a young offender population as a way of significantly improving service delivery for clinical teams working in prisons. Brief cognitive-behavioural interventions were administered to young offenders referred for problems with depression, alcohol and anger whilst in custody. Significant treatment effects were found at the time of follow-up, suggesting that the interventions significantly accelerated improvement in these problem areas. It is suggested that the two-plus-one model is both an appropriate and effective model of service delivery in working with this client group.

This paper suggests that a 24-hour perspective may be useful when considering attention and learning deficits. Sleep-wake schedules are placed within a conceptual model of arousal and attention, and it is argued that an “optimal” schedule may predict improved functioning. A synopsis of five clinical cases illustrates the application of behavioural treatment principles, designed to optimize the sleep-wake schedule. Although promising results were achieved, these must be taken as preliminary and it is hoped that further systematic study will be prompted.

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 central aspect of self-management of diabetes involves patients regulating the timing and intake of dietary carbohydrates. A 20 year old female diabetic patient was taught to identify deviations from appropriate dietary self-management, and a problem solving intervention was used to train new behavior in settings associated with such deviations. Dietary behavior and blood glucose levels were monitored in a diary and electronically, and treatment effects were evaluated in a multiple baseline across settings design. Treatment resulted in clear improvement in dietary management, and a substantial gain in blood glucose control at the end of intervention. At follow-up dietary change was maintained. Long term effects on blood glucose levels were confounded by a reduction in insulin dosage between treatment and follow-up.

A group of 54 clients with eating disorders who attended a college-based, group counselling service evaluated four treatments for eating disorders. Individual discussion of problems was uniformly rated as more acceptable than two behavioural treatments (systematic desensitization, and goals and relaxation) which were, in turn, rated as more acceptable than drug treatment. Methodological problems with this form of consumer evaluation and the need for further evaluation of behaviour therapy within a wider range of clinical populations are 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.

Long-term inpatients with severe psychiatric illness such as chronic schizophrenia can be very socially disabled. This makes it difficult for them to move on to more independent living because they lack many of the necessary social and practical skills. Social Economy Therapy (SET) is a practical approach which aims to improve social functioning. On a hostel ward, eight long term inpatients with severe and disabling psychiatric disorders started a SET programme. After two months the social and living skills of several patients were improved and a number were discharged to other accommodation.

This single case history reports the use of eye movement desensitization, a new cognitive therapy procedure originally developed for post-traumatic stress disorder and similar problems, to treat anxieties and body image problems resulting from operation scars and a degree of physical disability. The procedure was effective within one session and subsequent improvements in behaviour and cognitions reported.

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.

This report describes a placebo strategy which engendered a reasonable degree of positive expectation in 10 Generalized Anxiety Disorder patients and was perceived by them as being credible, sensible and appropriate at pre- and post-therapy and at six month follow-up. The significant improvement noted on a range of measures suggests that the strategy is not inert.

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.