This special edition of Behavioural and Cognitive Psychotherapy is dedicated as a tribute to Isaac Marks, who retires this year from his post as Professor of Experimental Psychopathology at the Institute of Psychiatry, London. All the contributors to this edition are colleagues who have been greatly influenced by Isaac during their careers. Their papers were written without Isaac knowing of our plans and we were even cheeky enough to ask Isaac to write a paper himself, reflecting on his 40 years involvement in the development of behavioural and cognitive psychotherapies. All the papers, including the one by Isaac himself, illustrate some of the areas where he has made a major contribution to behavioural and cognitive psychotherapies during the last 40 years.

Two papers, by Hand and by Rowa, Antony and Swinson, detail the huge advances made in the treatment of the severe and disabling disorders of agoraphobia and OCD, identifying Isaac's enormous contribution. The papers also confirm the international scope of Isaac's influence. These authors remind us not to forget the relative modernity of effective psychological treatments for these disorders and how dramatic a change there has been in prognosis and clinical outcomes.

Cognitive theorists propose that each anxiety disorder is associated with a specific tendency to overestimate the danger inherent in particular situations or internal states. Studies comparing anxious patients with non-patient controls have shown that several anxiety disorders are associated with elevated subjective estimates of the likelihood (probability) and cost of negative events. The present study focuses on social phobia and extends previous findings by: a) including a control group of equally anxious patients with another anxiety disorder and b) investigating the effects of successful cognitive and drug treatments on patients' probability and cost estimates. In line with cognitive theory, the results indicate that social phobia is associated with a specific elevation in subjective estimates of both the probability and cost of potentially negative social events. Reductions in overestimation occurred in successful cognitive and drug treatment and were closely related to the degree of symptomatic improvement in both treatments. Contrary to previous findings, there was no evidence that reductions in cost were more important than reductions in probability.

As of 1 October 2000, the editorial office for the journal moves to a different address, when I take up a new post in London. I will be sorry to move from Oxford, but welcome the opportunities and challenges of a new job. I will try to continue to edit the journal at least as well as before! Manuscripts for publication (and all other related material) should be directed to:

Professor Paul Salkovskis, Editor, Behavioural and Cognitive Psychotherapy, Department of Psychology, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.

This article argues for the benefits of a revision of cognitive therapy for depression around two main points. First, compared to recently developeded models for other disorders, our knowledge of cognitive content in depression is out of date and attracting little research, as if there is no more to be learned about what depressed people think and feel. Recent trends to challenge cognitive processes, without addressing the relevant content, might therefore meet with limited success, depending on how the content and processes are linked. Second, re-reading Beck et al. (1979) suggests the importance of exploring the meanings attached to precipitating events, a cognitive strategy that has fallen into the background, is probably used in an ad hoc fashion, and needs to be used more systematically to improve clinical effectiveness.

The present study evaluated the relative importance of different cognitive factors (anxiety sensitivity and trauma-related beliefs) in predicting PTSD symptom severity and treatment-related changes in these symptoms. Eighty-one victims of motor vehicle accidents (MVAs) completed self-report measures of PTSD symptoms, anxiety sensitivity (AS), MVA-related beliefs and control variables (e.g., medication use, pain severity). A subsample of patients (n=28), who received cognitive-behavioural treatment for PTSD, completed these measures pre- and post-treatment. For the combined sample (n=81), regression analyses indicated that AS and pain severity were significant predictors of PTSD symptoms, whereas MVA-related beliefs were not. For patients completing treatment, regression analyses indicated that reductions in AS and pain severity were significant predictors of reductions in PTSD symptoms. MVA-related beliefs did not significantly predict symptom reduction once AS, pain severity and medication status was controlled for. These findings suggest that AS is a significant cognitive risk factor for exacerbating and maintaining PTSD symptoms. Treatment implications are discussed.

Over the last 40 years certain psychosocial treatments have made great strides on the long road towards becoming a reliable clinical science. A mark of this maturation is the recent enabling of sufferers from anxiety disorders and depression to help themselves when guided by particular manual or computer self-help systems, indicating that several effective therapeutic mechanisms have become reasonably defined. Still unknown, however, is exactly how many separate therapeutic paths are being trodden to improve anxiety and depression, and how much various tracks converge on common mechanisms. Careful dismantling studies may in time reveal that some behavioural, cognitive and interpersonal therapy procedures are in fact proxies for administering as yet dimly-perceived therapeutic principles. Progress would accelerate further once therapists were required to specify how much they improve their patients on simple and widely-agreed measures of outcome and cost, and once they learn to speak a broad-accepted common language.

Several authors have suggested that threat schemata of high worriers may differ from those of less worried individuals with regards to the manner with which information is structured in the Long Term Memory (LTM) or the content of the information stored in the LTM. The present study tested this hypothesis using the catastrophizing interview technique (c.f., Vasey & Borkovec, 1992). Results revealed that high worriers evaluated the likelihood of the occurrence of feared consequences generated for each worry as more likely to actually happen than low worriers did. Second, the ultimate outcome generated in the catastrophizing sequence for a given worry was more severe for high worriers. Finally, high worriers generated ultimate outcomes that were more similar in content, presumably reflecting tightly organized threat schemata. It is argued that activation of these threat schemata in the LTM contributes to the maintenance of worry and anxiety in anxious individuals.

Intrusive thoughts, flashbacks, panic attacks and sudden physiological arousal are each experienced as involuntary, are difficult to control, and lead to considerable distress. Such observations have led to the suggestion that anxiety disorders are associated with the operation of automatic information-processing biases. Clinical and experimental evidence for this proposal is reviewed and three different classes of routes to the development and modification of these automatic processes are described: an innate route, repetition/habituation, and conscious appraisal. The review focuses in particular on the third route, proposing that automatic processing biases can be altered by accessing and modifying conscious appraisals of internal and external events. Indirect evidence is provided by selective attention paradigms in anxiety, treatment studies and clinical observations, although further research will be necessary for a direct test of the pathway. The implications for the theory and practice of psychological therapy for anxiety disorders are described.

Motivational interviewing is a client centred behavioural therapy for addictive behaviours. It is an intervention designed to help all addicts, not just those ready to change. It is therefore suitable for use as an opportunistic intervention for clients whose main reason for contact may not be their addiction. A pilot randomized controlled trial of home-based motivational interviewing by a specially trained midwife to help pregnant smokers reduce their habit was performed in Glasgow from February 1997 to January 1998. Did motivational interviewing take place? All 171 counselling interviews from 48 intervention clients were audio-taped. Forty-nine interviews from 13 randomly selected clients were transcribed for content analysis. A rating scale established for feedback to trainee psychologists was used by three experienced analysts. Thirty-two interviews were scored independently to validate the rating scale in this setting. More than 75% of interviews showed satisfactory motivational interviewing. Therapist utterances were motivational, and client responses included many self-motivational statements. Few episodes of client resistance were recorded. Rating took 160 mins per half hour interview. This instrument provided a valid measure of intervention quality for a randomized controlled trial. It would not be practical to document process outside a research environment.

Motivational intervention, a strategy to increase motivation for change, was tested as an addition to treatment at the start of an outpatient programme for alcohol dependence. Admissions to the programme were randomly allocated to either a motivational or educational procedure. The three motivational constructs of the SOCRATES-8A Readiness to Change questionnaire (Ambivalence about change, Recognition of problems, Taking Steps to change) were used as measures of motivation for change. At one week post-intervention, motivational participants reported significantly greater levels of problem recognition. The motivational group's post-intervention scores were significantly higher on the Taking Steps scale and significantly lower on the Ambivalence scale. There was no difference on measures of engagement in treatment or drop-out from the outpatient treatment programme. For the population as a whole, a relatively low pre-intervention score on the Ambivalence scale was predictive of drop-out. Results support the efficacy of motivational intervention for decreasing self-reported levels of ambivalence about change and for increasing problem recognition and taking steps towards change. More detailed research with a longer follow-up period is needed to determine whether this has any impact on other vectors of motivation for change, including participation in treatment, outcome expectancy and drinking behaviour.

The question of which cut-off point would be more appropriate in the selection of sub-clinical obsessive-compulsive (OC) samples is an important methodological issue that has not been formally addressed, hence prompting the current study. Three groups of sub-clinical OC subjects, scoring 1, 1.5, and 2 standard deviations (SD) above the mean on the Padua Inventory, and a matched non-OC control group, were compared on various clinical and personality measures. As expected, the three sub-clinical groups had higher scores than the non-OC group on measures of OC symptoms (including obsessional slowness), depression, anxiety, and on personality measures of neuroticism, psychoticism, and obsessional traits. However, no significant differences were observed between the three sub-clinical groups on most measures, although the 2 SD group had higher scores on neuroticism and obsessional personality traits. It is concluded that a wide range of selection criteria can yield similar results that are interpretable within the current theoretical models of Obsessive-Compulsive Disorder (OCD). It is suggested that subjects with a diagnosis of OCD should be carefully excluded from sub-clinical studies. [A Spanish abstract follows the references.]

This paper reviews the research in agoraphobia in four areas: (i) Is the group application of exposure in vivo really the most effective treatment for agoraphobia? (ii) Does high group cohesion really increase the power of group exposure? (iii) Was the exposure mode applied in this study actually the first cognitive-behavioural intervention in behaviour therapy of anxiety disorders? (iv) How often do agoraphobics really suffer from marital discord, and how does this affect the outcome of short-term, massed exposure-treatment? It describes the development of concepts and the evolution of knowledge, but it also points out the redundancies, misunderstandings and pitfalls in research that have hindered progress. This paper does not deal with the data quality of the studies reviewed; sometimes high data quality does not result in high information quality, and vice versa. This is therefore not a scientific paper but a non-comprehensive journey through the recent history of research in behaviour therapy for agoraphobia. It is hoped to give practice-relevant information for clinicians and some new ideas for future research.

The aim of the study was to examine whether there are specific cognitive personality traits that are related to specific cluster C personality disorders as suggested by Beck's cognitive model. The study included 135 psychiatric outpatients and 41 healthy controls. The subjects were diagnosed according to DSM-III-R axis I and axis II. The cognitive dimensions of sociotropy, autonomy and dysfunctional attitudes were assessed. The results indicated some cognitive specificity, especially when the effects of a lifetime depressive disorder were statistically controlled for. Dependent personality disorder was significantly associated with higher scores on all sociotropic subscales and dysfunctional attitudes. Avoidant personality disorder was significantly associated with the sociotropic subscales “concern about disapproval” and “pleasing others” as well as dysfunctional attitudes, while obsessive-compulsive personality disorder was associated with only higher scores on the sociotropic subscale “concern about disapproval”.

Until the late 1960s, obsessive compulsive disorder (OCD) was considered to be a relatively untreatable condition. Over the next several years, many advances were made in the psychological treatment of OCD as clinicians and researchers began to realize the value of behavioural treatments for this population. Isaac Marks and his colleagues played an instrumental role in the development and initial validation of exposure-based treatments for OCD. In addition to his other important research in the area of anxiety, Marks continued to study behavioural treatments for OCD, including the processes and predictors of treatment outcome. More recently, his work has focused on self-administered treatments for OCD and other anxiety disorders, including computerized and telephone-based treatments. This paper reviews research on the behavioural treatment of OCD, with an emphasis on the contributions of Isaac Marks.

The Problem Solving Scale (PSS) is a 15-item questionnaire measuring the problem solving component of self-control behaviours. It is derived from the 36-item Rosenbaum Self-Control Schedule. This paper presents some preliminary psychometric data on the PSS from a sample of 153 patients referred for cognitive therapy. The paper reports descriptive statistics, Cronbach's Alpha Correlations, correlations of the PSS with the Beck Depression Inventory and Beck Anxiety Inventory and results of a Principal Components Analysis. The PSS has good internal reliability and, like the Self-Control Schedule itself, seems to measure a dimension of coping that is independent of age, sex and diagnostic status. The PSS may prove a useful instrument both to measure change in problem solving in therapy and to predict outcome.

Rational Emotive Behaviour Therapy (REBT) hypothesizes that the functionality of inferences is primarily affected by the preferential and demanding nature of rational and irrational beliefs, respectively. It is then, secondarily, influenced by the functional and dysfunctional contents to which rational and irrational beliefs, respectively, refer. This hypothesis was tested by asking 96 participants to imagine themselves holding one of four specific beliefs: a rational belief with a preference and a functional content, an irrational belief with a demand and a dysfunctional content, a rational belief with a functional content and no preference, and an irrational belief with a dysfunctional content and no demand. Participants imagined themselves holding their belief in an imaginary context, whilst rating the extent of their agreement to 14 functional and dysfunctional inferences. Contrary to REBT theory, results indicated that rational and irrational beliefs had the same magnitude of effect on the functionality of inferences, whether they referred to a preference/demand+contents, or only contents. The discussion maintains that preferences and demands may not constitute the principal mechanism through which rational and irrational beliefs affect the functionality of inferences. Instead, consistent with Beck's cognitive therapy, belief contents may constitute this primary mechanism.

The level of public satisfaction with mental health services is low. This is evident in adverse media coverage and the Government's view that community care has failed. Some components of a comprehensive mental health service are in disrepair and others are missing altogether. Surveys of those who use services show that many are dissatisfied with the care they receive. One of the actions that services must take to improve their effectiveness, acceptability and public image is to understand better what people want from the services they use. Surveys of service users have identified what these issues are. It is now important that these factors are incorporated into measurement instruments that can be used in routine practice settings. This paper summarizes what service users have indicated that they want from services, lists the desirable attributes of instruments that might measure these factors, and gives brief descriptions of four instruments that meet some aspects of the specification.

The present study examined the dysfunctional attitudes and the personality styles of 40 psychiatric outpatients with obsessive-compulsive disorder (OCD) and compared them to 33 outpatients with major depressive disorder (MDD) and 41 healthy controls (HC). Scores on Beck's Depression Inventory (BDI), Dysfunctional Attitude Scale (DAS), and Sociotropy-Autonomy Scale (SAS) were obtained for the three groups. Based on previous research it was predicted that higher levels of sociotropy subscales S 1 (concern about disapproval), and S 2 (attachment/separation concerns) would be specifically related to the diagnosis of OCD after controlling for differences in demographic variables and other psychiatric diagnoses. These hypotheses were confirmed. Significantly lower scores on subscale A 3 (solitary pursuits) was also found specifically related to OCD diagnoses. Higher scores on DAS and lower scores on autonomy subscale A 1 (independent achievement) were found to be particularly related to MDD. Implications of these findings for a cognitive model of the development of OCD are discussed.

Some studies suggest that self-focus contributes to the onset of depression. A new cogitive model of depression, the three-phase model of self-focus and depression, is presented here to explain the mechanism of the onset and maintenance of depression. In this model, the relationship between self-focus and the course of depression is divided into three phases: (1) initiation, (2) operation, and (3) maintenance. Previous studies examining the relationship between self-focus and depression are reviewed, within the framework of the model: (1) studies investigating situations that will initiate self-focus; (2) studies examining the effects of self-focus on behaviour, cognition, and affect; and (3) studies examining the duration of self-focusing. The model is then presented and propositions derived from it are outlined. Finally, suggestions are made for preventing depression, for recovery from it and for the scope of application of the model.

Large-scale cognitive-behavioural Stress Management workshops were run for members of the general public as part of a city-wide mental health promotion campaign. Four groups were compared: a workshop run over one day (Full-Day), one run over two half-days (Half-Day), a non-specific intervention control group, and a waiting list control group. Results indicate that the participants in the workshop groups improved more than those in either of the control groups, supporting the idea that the psychoeducational approach can be valuable and economical in a health promotion and public health context. The use of this format in clinical situations and in primary care settings is also discussed.