Experimental evidence suggesting that psychiatric comorbidity has important clinical and prognostic implications in bulimia nervosa has mostly been based on outpatient studies investigating a selection of co-existing psychopathological features with rather unstructured and not standardized diagnostic instruments. Using structured instruments (SCID-P, MDCL) for the diagnoses of DSM III-R axis I disorders and clinical interviews for the diagnosis of DSM III-R axis II disorders in 24 hospitalized bulimics, the present study demonstrated that more than half of the patients had two or three axis I disorders in addition to bulimia nervosa and almost half of the patients met criteria of at least one personality disorder. Subgroups of patients classified according to the type of psychiatric comorbidity did not differ significantly with respect to clinical features; regarding measures of hospital behavior therapy outcome. However, the findings provided evidence for a negative impact of anxiety disorder in addition to bulimia nervosa on the improvement of bulimic behavior and possibly also on self-rated depression.

Skinner is, without a doubt, one of the most predominant figures in the development of Behavior Modification and Behavior Therapy. Skinners' work is essential to the development of Behavior Modification and Behavior Therapy. Beginning with the social need for efficient psychotherapy, and after having generated a solid theoretical body of behavioral laws, Skinner indicated and also developed the appropriate path towards efficient interventions for unadaptive behavior. He developed a new theory regarding abnormal behavior (psychopathology), as well as a procedural model for evaluation (diagnosis) and intervention: “The functional analysis of behavior”. His applications for this kind of work are pioneering and at the same time, he is the agglutinant figure of what we today call “Behavior Modification and/or Therapy”.

It is remarkable that a scientist could change the theories and practices of a discipline as radically as Skinner and his work did. His work, however, still has its limitations. The best way to acknowledge and pay tribute to Skinners' work is to overcome these limitations.

The foundation, achievements, and proliferation of behavior therapy have largely been fueled by the movement's foundation in behavioral principles and theories. Although behavioral accounts of the genesis and treatment of psychopathology differ in the extent to which they emphasize classical or operant conditioning, the mediation of cognitive factors, and the role of biological variables, Pavlov's discovery of conditioning principles was essential to the founding of behavior therapy in the 1950s, and continues to be central to modern behavior therapy. Pavlov's reliance on a physiological model of the nervous system, sensible in the context of an early science of neurology, has had an implication for behavior therapists interested in the study of personality types. However, Pavlov's major legacy to behavior therapy was his discovery of “experimental neuroses,” shown by his students Eroféeva and Shenger-Krestovnikova, to be produced and eliminated through the principles of conditioning and counter-conditioning. This discovery laid the foundation for the first empirically-validated behavior therapy procedure, systematic desensitization, pioneered by Wolpe. The Pavlovian origins of behavior therapy are analyzed in this paper, and the relevance of conditioning principles to modern behavior therapy is demonstrated. It is shown that Pavlovian conditioning represents far more than a systematic basic learning paradigm. It is also an essential theoretical foundation for the theory and practice of behavior therapy.

The long-term persistence of neurotic symptoms, such as anxiety, poses difficult problems for any psychological theory. An attempt is made to revive the Watson-Mowrer conditioning theory and to avoid the many criticisms directed against it in the past. It is suggested that recent research has produced changes in learning theory that can be used to render this possible. In the first place, the doctrine of equipotentiality has been shown to be wrong, and some such concept as Seligman's “preparedness” is required, that is the notion that certain CS are biologically prepared to be more readily connected with anxiety responses than others. In the second place, the law of extinction has to be amended, and the law of incubation or enhancement added, according to which the exposure of the CS-only may, under certain specified conditions, have the effect of increasing the strength of the CR, rather than reducing it. The major conditions favouring incubation are (1) Pavlovian B conditioning, that is a type of conditioning in which the CR is a drive; (2) a strong UCS, and (3) short exposure of the CS-only.

The present study explored whether and how self-injurers attempt to resist urges to harm themselves. Participants were 39 young adults with a history of skin cutting and other non-suicidal self-injurious behaviors. A structured interview assessed the prevalence and perceived helpfulness of 48 methods for resisting self-injurious urges. Ninety percent of participants indicated that they had made efforts to resist urges to self-injure. These individuals had used an average of 16 different methods, and reported that they were successful in resisting the urges most of the time. “Keeping busy” and “Being around friends” were the most common methods used to resist self-injurious urges. However, “Doing sports or exercise” and “Removing the means/instruments typically used to self-harm from the home” were rated as being the most helpful for resisting self-injurious urges. Findings have implications for enhancing treatment and guiding future research.

Background: Behavioral symptoms of dementia are common among residents in mainstream aged care settings, and have a substantial impact on residents and professional caregivers. This study evaluated the impact of individualized psychosocial interventions for behavioral symptoms through a small preliminary study.

Method: Interventions were delivered to a patient group of 31 psychogeriatric aged care residents who presented with behavioral symptoms of dementia that had failed to respond to pharmacological treatment approaches. Outcome data on severity of behaviors, health service utilization and staff burden of care were collected.

Results: A modest but significant reduction in staff ratings of the severity of aggressive and verbally agitated behavioral symptoms was found, with an associated reduction in their perceptions of the burden of caring for these patients. Reduced behavioral disturbance was associated with a reduction in the requirement for primary care consultations, and all participants were able to continue to reside in mainstream aged care facilities, despite an increase in the severity of dementia.

Conclusions: This study supported the use of individualized psychological strategies for behavioral symptoms at all stages of dementia. Methodological limitations of this preliminary study are discussed.

Objectives: The present study evaluated the cost-effectiveness of a behavioral graded exercise therapy (GET) program compared with usual care (UC) in terms of the performance of daily activities by patients with chronic shoulder complaints in primary care.

Methods: A total of 176 patients were randomly assigned either to GET (n=87) or to UC (n=89). Clinical outcomes (main complaints, shoulder disability [SDQ] and generic health-related quality of life [EQ-5D], and costs [intervention costs, direct health care costs, direct non–health-related costs, and indirect costs]) were assessed during the 12-week treatment period and at 52 weeks of follow-up.

Results: Results showed that GET was more effective than UC in restoring daily activities as assessed by the main complaints instrument after the 12-week treatment period (p=.049; mean difference, 7.5; confidence interval [CI], 0.0–15.0). These effects lasted for at least 52 weeks (p=.025; mean difference 9.2; CI, 1.2–17.3). No statistically significant differences were found on the SDQ or EQ5D. GET significantly reduced direct health care costs (p=.000) and direct non–health care costs (p=.029). Nevertheless, total costs during the 1-year follow-up period were significantly higher (p=.001; GET=€530 versus UC=€377) due to the higher costs of the intervention. Incremental cost-effectiveness ratios for the main complaints (0–100), SDQ (0–100), and EQ-5D (−1.0–1.0) were €17, €74, and €5,278 per unit of improvement, respectively.

Conclusions: GET proved to be more effective in the short- and long-term and reduces direct health care costs and direct non–health care costs but is associated with higher costs of the intervention itself.

This is report of the successful use of behavioral treatment in a medical crisis. The intubation process inadvertently punctured a patient's throat during the application of general anesthesia while having a routine arthroscopy. This resulted in a rapidly spreading infection, spiking temperature and dehydration. To locate the puncture, a barium swallow x-ray was necessary, but the patient's weakened condition made standing impossible. A friend and experienced therapist accompanying the patient helped him stand for the several minutes necessary to complete the barium swallow by countering the hypotensive state with angry imagery to stimulate an adrenalin surge. Several principles of effective therapeutic practice were demonstrated by this case, including the importance of the alliance, of technical eclecticism, of engaging the patient in the treatment process, and therapist experience.

The objective of this study was to evaluate a multi-component behavioral intervention for child distress during repeated needle sticks. An AB single-subject experimental design with replication of procedures across five subjects was used to assess intervention effects on distress and procedure duration for five children (age 3–7 years). Playing preferred activities, signaled button pressing, and following directions were positively reinforced first during simulated then actual needle procedures. The results indicate that distress decreased substantially for three children, slightly for a fourth and was unchanged for one. Heart rate (HR) data obtained from one child provided preliminary evidence of counterconditioning. For three children with follow-up data, benefits were maintained after intervention transfer to caregivers. In conclusion, distraction and counter-conditioning appear to be compatible conceptualizations for designing interventions to reduce the distress of experienced children who undergo repeated invasive procedures. The independent and synergistic effects of behavioral interventions based on these two theories should be examined in future studies.

Families of 99 children with early-onset conduct problems, aged 4–8 years, were randomly assigned to a child training treatment group (CT) utilizing the Incredible Years Dinosaur Social Skills and Problem Solving Curriculum or a waiting-list control group (CON). Post-treatment CT children had significantly fewer externalizing problems at home, less aggression at school, more prosocial behavior with peers, and more positive conflict management strategies than CON children. Significantly more CT than CON children showed clinically significantly improvements on reports and independent observations of aggressive and noncompliant behavior. The differential treatment response was evaluated according to child comorbidity with attention deficit hyperactivity disorder (ADHD), parenting discipline practices, and family risk factors. The only risk factor related to failure to make improvements in child conduct problems after treatment was negative parenting (i.e., maternal critical statements and physical force). The long-term follow-up 1 year later indicated that most of the significant post-treatment changes were maintained.

This paper reviews the treatment of obsessive-compulsive disorder (OCD) in children and adolescents. Focusing on clinical features of the disorder and its treatment particular to pediatric onset, diagnosis, assessment, and behavioral, pharmacological, as well as new investigative treatments are covered. Adaptation of cognitive-behavioral therapy for children and adolescents, use of augmenting agents in drug treatment, and subtyping of OCD cases are developments relevant for current practice.