There is increasing support for the use of systematic psychological interventions in combination with pharmacotherapy in the treatment of bipolar disorder (BD). A “manualised” approach, such as cognitive behaviour therapy (CBT), can be used to facilitate adjustment to the disorder, increase the acceptability of prescribed medications and reduce morbidity. This paper outlines psychosocial issues of relevance to individuals with BD and a model to engage individuals in therapy is described. A brief overview is given of some of the interventions that may help sufferers identify and control the acute symptoms of BD, reduce the risk of relapse and improve how they cope with the disorder and its treatment. The available outcome data on the use of CBT and the need for research are also noted.

Obsessive-compulsive hoarding can be viewed within personality, neuroethological and cognitive-behavioural frameworks. Three cases of obsessive-compulsive hoarding are described in detail. All cases had some insight (albeit fluctuating) into their problem and were seeking treatment. There was evidence of abnormal risk assessment, fear of criticism, excessive guilt, overconscientiousness and inflated responsibility. Depression, emotional or material deprivation and significant loss during childhood and adolescence were experienced by all cases. The cases are considered to be consistent with a cognitive-behavioural model of obsessive-compulsive disorder emphasizing the importance of learning and cognition. Implications for treatment are discussed.

Although body image problems are a major prognostic factor in the course of eating disorders, its treatment has received little attention in the research literature. We present two psychophysiologically controlled cases of intensive exposure treatment with conflicting outcomes. Pre-post treatment assessments included measurements of body size estimation, body related avoidant attitudes and body dissatisfaction. In case 1, although dissatisfaction and avoidant attitudes decreased, body size overestimation remained basically unchanged. Case 2 did not improve. Psychophysiological recordings showed a covert avoidance of treatment stimuli. We discuss the pros and the cons of the treatment, and the implications for the use of exposure therapy in body image disorders.

The present study investigates the differences between panic disorder patients with and without angina-like chest pain. The patients were diagnosed according to DSM-III criteria and were divided into chest-pain and no chest-pain subgroups according to the occurrence of angina-like chest pain during their panic attacks. In the first stage of the study, transcutaneous arterial CO2 tension was recorded at rest, during and after a hyperventilation provocation test in 20 panic patients (8 with chest pain and 12 without chest pain during panic attacks) and 23 matched control persons. In the second stage of the study, panic symptom checklists, panic diary, depression, anxiety and fear questionnaires, and surface integrated EMG were documented in 85 panic patients (43 with chest pain and 42 without chest pain during panic attacks). The resting pCO2 level was significantly lower in panic patients with chest pain compared to the controls and to panic patients without chest pain. The pCO2 level after recovery was also significantly lower in the chest pain panic group than in controls. Further significant differences were identified between the two subgroups of panic patients, although the initial mean anxiety level failed to differentiate between subgroups. The surface integrated EMG and the sum of panic symptom checklist were higher in the chest-pain subgroup. The derealization score and the suicide subscale of Beck Depression Inventory were significantly higher in the no-chest pain group. These results underline the significance of reduction of pCO2 level in panic attacks with angina-like chest pain; that is, the significance of dissociation of cardiorespiratory and metabolic responses in this group of patients. These findings may offer an important link in the understanding of physiological responses in anxiety attacks.

Visual analysis, or “eyeballing”, of single subject (N=l) data is the commonest technique for analysing time series data. The present study examined firstly, psychologists' abilities to determine significant change between baseline (A) and therapeutic (B) phases, and secondly, the decision making process in relation to the visual components of such graphs. Thirdly, it looked at the effect that a training programme had on psychologists' abilities to identify significant A−B change. The results revealed that the participants were poor at identifying significant effects from non-significant changes. In particular, the study found a high rate of false alarms (Type 1 errors), and a low rate of misses (Type 2 errors), i.e. high sensitivity but poor specificity. The only visual components to significantly alter decisions were the degree of serial dependency and the mean shift component. The teaching influenced the participants' judgements. In general, participants became more conservative, but there was limited evidence of a significant improvement in their judgements following the teaching.

The marital satisfaction of sixteen maritally distressed couples who received three sessions of Brief Behavioural Couples Therapy (BBCT), and 24 couples who received 12 to 15 sessions of Traditional Behavioural Couples Therapy (TBCT), were compared before and after treatment in a quasi-experimental design. A 2 way ANOVA of treatment (BBCT versus TBCT) by time (pre- and post-treatment) showed both conditions produced significant increases in marital satisfaction, but there were no significant differences between the effects of the two treatments. The results need replication within a true experimental evaluation, but suggest that brief behavioural couples therapy may be a viable treatment option for some distressed couples.

This paper describes a case concentrating on the psychological conceptualization and treatment of phantom pain. A single session of cognitive work, teaching an “attention diversion’ strategy, was effectively utilized for the treatment of below knee phantom pain in an elderly lady. A follow-up, approximately one year later, revealed that the treatment gains had been maintained. Although a review of the literature (Sherman, Sherman and Gall, 1980) presents a rather murky picture as regards treatment prospects, the results nevertheless illustrate how a very simple cognitive strategy was successfully employed to alleviate a long standing debilitating phantom pain.

Psychological management is a crucial part of the overall treatment plan involving therapeutic amputations in children. Therapeutic work aims to facilitate the implementation of a coordinated treatment plan taking into account the patient's physical and psychological needs. Psychological contact at the early stage is advocated to minimize the patient's distress and to forestall potentially handicapping emotional disturbances. The paper highlights important issues at different phases of the patient's treatment, including coming to terms with the initial diagnosis, acceptance of the amputation plan, and the final process of rehabilitation and normal life adjustment. Psychological interventions with one adolescent girl treated with therapeutic amputation for osteosarcoma are used to illustrate the therapeutic process.