The tendency to dissociate is characterized by deficits in autobiographical memory. Poor reality monitoring, i.e., the ability to decide whether an event truly happened or was imagined may give rise to autobiographical memory problems. It was hypothesized that the tendency to dissociate, as measured by the Dissociation Experience Scale (DES), is related to deficiencies in reality monitoring. Yet, the results of two laboratory measures of reality monitoring showed no such relationship in a sample of undergraduate students scoring high on the DES. The tendency to dissociate was found to be related to self-reports of traumatization. This association, however, was mediated by a measure of deliberate attempts to suppress memory elements from entering consciousness. This finding suggests that memory problems relating to trauma may be due to “willful forgetting”.

The aim of the study was to develop a cognitive behavioural treatment model for medically unexplained physical symptoms and assess its feasibility and effect in a small sample of patients. This study was the first step in the realization of a randomized controlled trial. The study population consisted of consecutive patients presenting at a general medical outpatient clinic, whose symptoms could not be explained by objective abnormal findings. The treatment was based on a general model of the disorder, consisting of the physical symptoms, the patient's attribution and perceived control and the cognitive, behavioural, physical and social consequences. It incorporated record keeping concerning physical symptoms and emotions, identification of cognitions about the symptoms, challenging dysfunctional thoughts and behavioural experiments. At 6–months follow-up, four of the five treated patients were improved with regard to frequency and intensity of the symptoms, psychological distress and functional impairment. The improvement was sustained at 1–year follow-up.

ECT has been administered to infants, children and teenagers between the ages of two and eighteen, in Europe, North America and Australasia. There are several alternate forms of effective behavioural and cognitive interventions for the range of problems experienced by minors. In this paper, some of the reasons for the contemporary popularity of ECT administration with children and teenagers are explored, via a critical evaluation of the published literature.

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.

This study examined the correlates of overgeneral memories (i.e., non-specific memories) in normal subjects. Subjects were instructed to generate five personal memories in response to positive cue-words and five memories in response to negative cue-words. As predicted, no evidence was found for a positive association between overgeneral memories and level of depression. Neither was there an association between low memory specificity on the one hand and neuroticism and trait anxiety on the other hand. A significant though small correlation was found between hemisphere thinking style and specificity of personal memories. Surprisingly, the direction of this correlation was such that the more subjects relied on a left hemisphere mode of thinking (i.e., analytic and verbal processing), the more overgeneral their memories were. Taken together, the results indicate that in normal samples, depression symptoms, neuroticism or trait anxiety do not represent important correlates of overgeneral memories consistent with their status as trait markers uninfluenced by state factors.

In reply to Jones and Baldwin's paper, the current practice of electroconvulsive therapy (ECT) is described with a retrospective case study. Particular reference is made to: indications, consent, immediate and longer term outcome. It is argued that the treatment is beneficial, but systematic audit is necessary.

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.

Testing a variant of Wegner's (1989) “thought suppression” paradigm, we had subjects identify a personally-relevant negative thought that had been troubling them recently. Subjects were then randomly assigned either to a negative target thought group or to a neutral target thought (“white bear”) group, and randomly assigned either to an initial suppression condition (followed by a free expression period) or an initial free expression condition (followed by a suppression period). The results revealed that subjects in the neutral thought group experienced a decline in thoughts about white bears throughout the course of the experiment, whereas subjects asked first to suppress a personally relevant negative thought experienced nearly a three-fold increase in its frequency of occurrence when later given permission to express it. These findings suggest that negatively valent thoughts may respond differently than neutral thoughts following attempts to suppress them.

Forty-three children with recurrent abdominal pain who had received treatment from a paediatric gastroenterology clinic were reassessed 6 and 12 months after initial presentation. Measures of children's pain included a pain diary (PD) which measured pain intensity, a parent observation record (POR) which assessed pain behaviour and a structured interview to assess the degree to which pain interferes with the child's activities. Pretreatment measures of the child's history of pain, coping strategies in dealing with pain, and their mother's caregiving strategies were examined as predictors of two indices of clinical improvement: the extent of change in pain on the child's pain diary from pre-test to 6 months follow-up, and the degree of interference to the child's activities. All children had shown significant improvement in the level of pain at follow up, with 74.4% being pain free at 12 month follow-up on the PD and 83.7% being pain free on the POR. The amount of change they showed varied, with some showing residual impairment even though they were significantly improved. Regression analyses showed that children with greatest reductions on the child's pain diary at the 6 month follow-up were those with a stress-related mode of onset, whose mothers used more adaptive caregiving strategies, and who received cognitive behavioural family intervention. There was also a non significant trend for younger children to fare better. These data suggest the importance of early diagnosis and routinely assessing parental caregiving behaviour and beliefs about the origins of pain in planning treatment for children with RAP.

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 explored factors associated with the successful suppression of dentist-related thoughts. Fifty-eight subjects first completed questionnaires on dental anxiety, trait anxiety, cognitive self-efficacy, and negative cognitions related to dental treatment. After imagining a scene in which they were undergoing dental treatment, subjects were asked to identify the negative thoughts they had just experienced. Next, subjects were instructed to suppress these thoughts during a one minute period. After this suppression period, subjects rated the extent to which they had succeeded in suppressing their dentist-related thoughts (i.e., thought control) and the extent to which they had spent on thinking about these thoughts (i.e., intrusiveness). The results showed that dental anxiety was negatively correlated with successful thought suppression, while trait anxiety was negatively associated with intrusions during the suppression period. It is suggested that anxiety undermines adequate cognitive control.

Comprehensive evaluation of the risks and benefits of applying ECT to young minds would probably not support the practise. This paper explores why some practitioners continue to choose ECT over viable alternative interventions, and argues for improved safeguards against unnecessary and potentially harmful treatments. Ethical decision making must look beyond rapidity of treatment effects, and consider the pros and cons of all available treatments.

Motivational Interviewing (Miller, 1983; Miller and Rollnick, 1991) is an approach originally developed for problem drinkers but assumed to have wider applications. This paper describes one such application through the case of Mr D, an imprisoned sex offender who was identified under the procedures of the Prison Service Sex Offender Treatment Programme. Mr D was convicted of rape but did not believe that he had committed an offence, although he admitted having had sexual intercourse with the complainant. A full assessment of his offending suggested that he had made cognitive and behavioural errors prior to the act of intercourse and so motivational interviewing was employed to help him decide whether or not to participate in the treatment programme. As a result he decided that he would attend a treatment group. The case study concludes with a brief description of his progress whilst in the group and summarizes the results of the follow-up assessment. The application of motivational interviewing to this particular client group is discussed.

In a diverse therapeutic context, multiple interventions are available for use with disordered or dysfunctional minors. With this population, electroshock administration is always inappropriate.

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.

The range of areas where cognitive-behavioural treatment (CBT) is applied has been considerably extended over the previous decade. This paper describes the application of CBT in the German health care system as typified by a random sample of 1,344 cases. Content analysis was used, and indicates a generally appropriate pattern of treatment strategy. Cognitive components were more prominent than behavioural ones in the description of treatments used.

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 introduction of two sessions a day on two days a week of cognitive and physical stimulation was found to reduce the stereotypic behaviour of a woman with a profound learning disability. The effect was shown to last for several hours with indications that it may have lasted several weeks.

An eighteen month follow-up of chronic nightmare sufferers treated with imagery rehearsal, a cognitive-behavioral method, demonstrated significant and clinically meaningful decreases in nightmare frequency. Sixty-eight percent of subjects decreased their nightmares below criteria for a “Chronic Nightmare Disorder”. Significant improvement was also noted for sleep quality and daytime anxiety. The findings support the theory that nightmares may be clinically conceptualized as a primary sleep disorder in some chronic sufferers.

The aim of this paper was to test the comparative effectiveness of three therapeutic modalities: a) individual stimulus control and exposure with response prevention; b) group cognitive restructuring; and c) a+b in the treatment of pathological gambling with slot machines. An additional waiting-list group was used to evaluate the spontaneous evolution of the non-treated gamblers. The sample consisted of 64 patients selected according to DSM-III-R criteria. A multigroup experimental design with repeated measures (pretreatment, posttreatment and 1, 3, 6 and 12-month follow-up) was used. Most treated patients gave up gambling as well as improved, albeit more slowly, in family/social and psychological functioning. The success rate was higher in the individual treatment compared both to group and combined treatment. There was also an improvement in gambling in the control group between the pretreatment and the 6–month follow-up and there was no difference between the combined treatment and control group. Individual stimulus control and exposure with response prevention appears to be a cost-effective therapy for pathological gambling. Implications of this study for clinical practice and future research in this field are discussed.