This paper presents two studies which attempt to clarify the processes by which families who have multiple problems respond to behavioural parent training procedures. Study 1 assessed a range of parent and child behaviours in diverse home and community childcare settings during baseline, child management training and 3-month follow-up. Results show that while treatment gains occurred in the home training setting with the therapist present, little generalization of therapeutic effects to other settings was found. At follow-up, the gains made in the training setting had largely reverted to baseline levels. Study 2 assessed the same parent and child behaviours across settings for another group of multidistressed families during baseline, child management training, generalization training (consisting of planned activities and a social-marital support intervention) and at follow-up. Results indicated that the generalization training was associated with further improvements in non-training settings for parent and child behaviour, and that these results had maintained or further improved at follow-up. The results are interpreted and discussed with reference to future research and clinical work with conduct disordered children and their families.

Dependency levels of long-term mentally disabled people in hospital and community settings were compared using a behavioural rating scale called REHAB in a health district where a policy of community care had been implemented. It was found that the performance of subjects in the community settings was better than those on the admission ward, but was worse than half the people normally found in traditional psychiatric settings. The policy of community care would seem to have been successful insofar as this group of subjects was able to remain in community settings. Comparison of the REHAB factor scores suggested differences in the behavioural competence of subjects supported by community psychiatric nurses and social services staff compared to those attending a psychiatric day hospital.

Although cognitive restructuring (CR) procedures have not proven very helpful for phobics in recent studies, insight and rehearsal components of CR have often been confounded. To seek possible differences in effectiveness between insight and rehearsal, we treated 16 phobics (eight agoraphobics and eight others) with four sessions of each method, using a counterbalanced crossover design with 1-month follow-ups after each treatment component. Significantly fewer sessions were attended by the clients in the rehearsal/insight sequence, and benefit ratings made by project completers significantly favoured insight/rehearsal. Few other treatment group differences were seen, but those that emerged gave the advantage to insight. Rehearsal seemed unhelpful, particularly to non-agoraphobics. Conclusions are (1) that CR methods show some promise in application to phobias, provided that self-exposure homework forms the core of the treatment plan, and (2) that insight followed by rehearsal is the preferred sequence.

The use of room management techniques to increase the levels of engagement of people with a mental handicap has been well documented. The difficulties in using constructional approaches (as opposed to eliminative procedures) to deal with difficult and disruptive behaviour in residential settings has also been well documented. This study reviews the relevant literature and describes in detail the application of a room management technique in a women's hospital villa. The six residents who took part are described as severely mentally handicapped, difficult and disruptive. During the room management sessions the levels of engagement in purposeful activity of the women increased and the problem behaviour exhibited decreased. Both changes were statistically significant. The implications of these findings for the general management of people who exhibit difficult and disruptive behaviour are discussed.

Anecdotal evidence suggests that room management is useful in controlling the frequency of behavioural excesses in severely/profoundly handicapped persons. This study involves a systematic investigation of the effect of room management on inappropriate behaviour. Data was collected over a 10-day period on each of six subjects who manifested a range of stereotyped and self-injurious behaviours. Each day formed an ABA design, A representing baseline conditions and B, room management. Room management proved to be helpful in controlling the behaviour in some instances. For other subjects it was clearly not successful. This outcome is discussed in terms of inter- and intra-subject variability in response to environmental change.

Peer interaction problems are often difficult to ameliorate in a clinical setting. In this study, four boys, whose many problems included difficulties with peer relationships, were given social skills training in a group over ten sessions. The main aim was to improve cooperative play, effective communication and conflict resolution skills by using a general problem-solving framework combining behavioural and cognitive techniques. The formal measures failed to show change, which may be due in part to inadequacies in the measures. Reports from therapists, teachers and parents suggested that there was considerable change within sessions, some improvement at school but very little at home.

A female irritable bowel syndrome sufferer was offered several strategies sequentially for coping with the complaint. Of these, bowel retraining established desired bowel frequency and exposure in fantasy resulted in decreased frequency and intensity of pain attacks. Both of these effects were maintained to 18-month follow-up.

Psychological treatments for sleep-maintenance insomnia have received little attention in the literature. Problems with staying asleep are commonplace, however, especially in the older age groups, and there is a need to develop effective management alternatives to night-time sedation. This single case report describes the sequential application of two cognitive interventions with treatment effects being evaluated by means of time series analysis. The mental overarousal model of sleep disturbance is discussed.