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.

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.

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.

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 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.

This paper will review the development of nurse therapy in England over a period of 28 years. By examining the data available on the efficacy of nurse therapists and the latest picture of the workforce, derived from a recently conducted survey, consideration will be given to how nurse therapy might develop in the future. In particular, the paper will provide an analysis of dissemination issues.

Mental health problems contribute 23% to the global burden of disease in developed countries (WHO, 1999). In the U.K., recent legislation attempts to address this by modernizing mental health services so that they provide evidence based, accessible and non-discriminatory services for both serious and common mental health problems. Cognitive behaviour therapy (CBT) has a robust evidence base that fits very well with the thrust of policy. However, CBT's delivery systems are rooted in traditional service models, which pay little attention to the growing evidence base for brief and single-strand treatments over complex or multi-strand interventions. Services characterized by 9-5 working, hourly appointments and face-to-face therapy disenfranchise the majority of people who would benefit from CBT. In this paper we argue that the evidence exists for service protocols that promote equity, accessibility and choice and that CBT services should be organized around multiple levels of entry and service delivery rather than the more usual secondary care referral systems.

This is a qualitative study in which the views and opinions of Professor Isaac Marks were sought from various nurse therapists using the loosest of interview schedules. The results are annotated and presented below.