The present study tested the hypothesis that involving the partners of headache sufferers in a group cognitive-behavioural stress-coping intervention for chronic headaches would enhance treatment outcome. A treatment program in which partners were involved (PI) was compared with a standard treatment program in which partners were not included (NPI) and a no-treatment control condition (NTC). The NPI condition was effective compared to the NTC condition, but there was less evidence that the PI condition was effective. No significant differences were found between the PI and NPI conditions at posttreatment or follow-up. These results are considered in terms of the usefulness of involving partners in group headache-treatment and the manner of their involvement. In addition, the possibility that partner involvement may actually detract from treatment effectiveness is discussed in terms of its impact on motivation and personal responsibility for change.

Self-instructional materials are widely used to help smokers develop cognitive-behavioural techniques which may assist them to stop smoking. The effectiveness of these materials may be augmented by a minimal therapist support component to encourage and supervise their use. Forty-five smokers were recruited to a smoking-cessation program at a community health centre, and were randomly assigned to either a self-instructional manual plus regular telephone contact condition, or to a manual-only condition. A higher proportion of participants in the telephone contact condition reported being abstinent at 3- and 6-month follow-ups, but not at a 12-month follow-up. There were no differences between the two conditions for the smoking rates of the remaining smokers at each of the follow-ups. Levels of adherence to the techniques presented in the manual were generally low, with a preference for the more-simple behavioural techniques, and those which were related to initial behaviour change rather than to maintenance. There was no relationship between levels of reported adherence to the techniques and smoking status at follow up. There is the need for further research on the cost-effective use of social support strategies to augment the impact of self-instructional behaviour-change materials.

Forty-five university students were assigned on a sequential basis to either a face-to-face or a self-help exercise program for 12 weeks. Pretests and posttests included anthropometric and physiological variables, field tests of aerobic capacity, and psychological variables which had previously been identified as predictors of adherence to exercise. Both groups showed significant increases in aerobic capacity and reported increases in general well-being, suggesting that self-help programs may be as effective as more structured interventions in facilitating exercise. However, self-reports 12 weeks later suggested that maintenance was quite poor for both groups. Measures of body composition showed few changes over 12 weeks. Psychological variables generally failed to predict success with either program. It is suggested that variables derived from narrowly social-cognitive approaches to health-related behaviour change may fail to take account of social and environmental constraints which may be important in understanding and predicting maintenance with health-related exercise.

Short-term social judgments that involve avoidance can contribute to the production of a habit that forecloses on later adaptation. When a child uses avoidance in one setting, and then in another, the child may have already begun the foreclosure process. Short-term decisions have long-term consequences, and to reduce anxious avoidance in youth is to increase long-range opportunities. Teaching behavioural and cognitive skills to increase social competence and adaptation will increase opportunities and increase choice. In the ideal situation, the plan is to encourage the development of coping skills, to encourage the family and the school to provide opportunities for coping, and to encourage the social system to provide the rewards that will maintain nonanxious nonavoidant behaviour. The thrust of this presentation is (a) to review and integrate behavioural and cognitive theories that guide us to understand the nature of anxiety in youth, (b) to describe intervention strategies that build childhood coping, and (c) to consider the necessary environmental changes that are needed to maintain treatment-produced gains.

During the past decade there has been a major advance in clinical management of schizophrenic disorders (Falloon & Shanahan, 1990; Lam, 1991; Schooler & Hogarty, 1987). This has resulted from application of strategies based upon a vulnerability-stress model of mental disorders. This considers mental disorders to result from interactions between specific biological vulnerability and non-specific environmental stresses (Falloon & Fadden, 1993).

Therapeutic interventions derived from this model combine biomedical strategies, predominantly optimal pharmacotherapy, with psychosocial strategies that aim to enhance the capacity of the index patient and his/her social network to cope with the impact of environmental stresses on the course of the disorder. Ten controlled studies have been published since 1980 that meet minimal standards of research design, with follow-up for at least 1 year (Bellack, Turner, Hersen, & Luber, 1985; Falloon, 1985; Gunderson et al., 1984; Hogarty et al., 1986; Leff, Kuipers, Berkowitz, Eberlein-Fries, & Sturgeon, 1982; Leff et al., 1989; Malm, 1982; McFarlane, 1990; Tarrier et al., 1988; Wallace & Liberman, 1985). Nine also provided 2-year results. Overall, these studies show that the addition of psychosocial strategies to optimal case management and long-term drug prophylaxis halves the rate of major clinical exacerbations in people suffering from schizophrenia. This benefit is most notable during the first year after a major schizophrenic episode, particularly when the psychosocial interventions encompass patients' immediate social support systems, usually the family or marital household (Falloon, 1985; Hogarty et al., 1986; Leff et al., 1982; Leff et al., 1989; McFarlane, 1990; Tarrier et al., 1988).

The treatment of persons with mental disorders is advancing rapidly. New epidemiological information has allowed the magnitude of the task to be specified. A census of mental health professionals has allowed the workloads to be determined and organisational models which focus on treatment in the community established. As diagnosis is the first step in treatment it is timely that new, computerised structured diagnosis interviews are available. Treatment evaluation likewise is able to suggest that medication and cognitive behaviour therapy backed by good clinical care are the keys to good patient treatment. The two major problems that follow mainstreaming of the treatment of persons with mental disorders are the reallocation of money to treatment in the community, and the education of mental health staff to diagnose and deliver the proven effective treatments.

An identical procedure to that of Pianta and Hudson (1990) was employed to reduce inappropriate sucking of fingers, hair, and clothes by a 7-year-old girl. The subject's mother utilised a simple response-cost procedure, which was faded over time, and social reinforcement to achieve substantial success. Follow-up observations conducted 6 months after the program terminated revealed a high degree of maintenance.

In addition to vomiting, clinicians and researchers have outlined several means by which women with bulimia nervosa purge, including fasting, exercise, laxatives, emetics, diuretics, thyroid hormone, fluoxetine, sorbitol, enemas, heroin, and tobacco (Bulik, 1992; Mitchell, Hatsukami, Eckert, & Pyle, 1985; Pyle, Mitchell, & Eckert, 1981). The following report presents an additional method of purging, namely with excessive dietary fibre, which was particularly reinforcing as it satisfied the need to binge and purge simultaneously.

Ms. A was a 27-year-old single white female who presented for outpatient treatment with a 1-year history of “out of control” binge-eating. She reported no prior history of any eating or weight disturbance. At the beginning of treatment she was 172.7 cm and weighed 64.5 kg (BMI = 21.6). She reported her desired weight to be 59 kg. The onset of her eating disorder was 1 year prior to treatment after moving, taking a new job, and beginning a relationship with a man whose diet consisted mainly of junk food.

During the first few months of the relationship, she gained (4–4.5 kg) and became quite concerned. She was distraught at not fitting into her clothes and disliked her body at that weight. She began a very restrictive diet, losing 6 kg in 2 weeks. Following that 2-week period, she “lost control” and began to binge-eat. This pattern of alternating binge and fast periods and 5 kg weight fluctuations continued for 1 year. With every subsequent binge period, she reported feeling more out of control.