To date clinical psychology research in primary health care has not taken sufficient account of the specific medical learning history of psychosomatic/anxiety patients and of the need to modify this learning process in therapy. In this pilot study a clinical judgement method is used to identify a group of primary care patients with physical symptoms where the general practitioner considers psychological factors highly relevant. Brief behavioural psychotherapy is defined and offered to those patients in order to provide effective approaches to their symptoms.

As a result different patient groups emerge: those who do not attend for their initial interview, those who attend only for their initial interview and those who attend for further sessions. These groups differ in general practice consultation rates prior to the intervention, and their consultation rates change differently following the intervention. The regular therapy attenders also differ from the “interview only” patients in terms of chronicity and degree of depressive symptoms. Significant symptomatic improvement was achieved for the therapy group. Further research is needed to identify the different groups of psychosomatic primary health care patients.

Behavioural ecology is a perspective within applied behaviour analysis which focuses on the complex relationship between interacting parts of a system, and particularly on the untargeted “side-effects” of interventions. This article considers two ecological effects of a large-scale nurse training venture in which 65 qualified psychiatric nurses received a one week in-service training in behaviour therapy. The effects of this training on two untargeted parameters, the nurses' clinical case notes (response generalization; N = 73) and ward teaching (generalization across subjects; N = 50) were evaluated via a combination of time-series and control group designs. The results indicated that the case notes became significantly more descriptive and less subjective, and that the learners developed significantly superior skills and knowledge in behaviour therapy as a consequence of the in-service training. These findings are discussed in terms of nurse training and behavioural ecology. The implication is that evaluations to date have generally been ecologically invalid, and that research on this topic would benefit from a more complex, naturalistic perspective.

This study applied a number of behaviour modification strategies in an attempt to reduce the level of disruptive classroom behaviour, and to programme for generalization of treatment effects across time and settings. Eight disruptive students represented either the Control, the Experimenter-selected Objects, or the Self-selected Activities Group. During intervention phases subjects in the Experimenter-selected Objects Group received school related material reinforcers for low levels of disruptive behaviour. The Self-selected Activities Group experienced a more complex set of conditions: partial self-determination of natural reinforcers, self-evaluation and recording, bonuses, group contingencies, individual progress graphs, eventual transition from continuous to intermittent reinforcement, and inclusion of common stimuli in the training and generalization settings. The results indicated that both reinforcement programmes dramatically reduced disruptive behaviour. The less complex package employed with the Experimenter-selected Objects Group, however, yielded significantly better generalization of treatment effects across time in the training setting, as well as across settings during the intervention phases. Additionally, this group showed significantly better maintenance of generalization across settings following programme termination.

Eleven residential care staff working in a secure unit with disruptive or delinquent youths were trained to use a variety of behavioural methods and teaching-parent interaction skills as outlined by the Achievement Place Programme. Three months following a 1-month full-time training programme, staff were observed in the work environment using a behaviour coding system. An attempt was made to identify which care staff behaviours influenced the clients' and colleagues' judgements about staff behaviour towards the youths. Staff who frequently asked for information from the youths were rated more positively by both colleagues and youths. The use of praise influenced the youths' judgements of care staff, whereas the expression of affection towards the youths influenced staff judgements of colleagues. Other aspects of conversation or teaching interaction skills did not correlate with boys' or colleagues' judgements of the care staff. Responses such as checking for understanding, requesting practice, giving prompts and feedback were rarely used by care staff. The study provides evidence of social validity for certain staff behaviours as influencing judgements made by clients and colleagues.

This is a report of a 29-year-old man who presented with (1) multiple phobias, including fears of eating with others, blood and injury, and fainting in crowds; (2) ejaculatory incompetence; and (3) grief unresolved five years after his first wife's death, causing distress and avoidance of grief cues. As he declined an offer of behavioural treatment for the grief, the intention of the case design was to measure changes in grief-related distress and avoidance, but not treat it. However, exposure in vivo for the largely non-grief-related phobias involved inadvertent exposure to cues for grief and the man initiated some self-directed exposure to cues for grief. Measures indicated reduction in both phobic and some grief-related symptomatology. Mechanisms possibly accounting for these changes, and difficulties encountered in trying to treat this phobia while leaving grief untreated, are discussed. It is suggested that under certain circumstances, grief pathology may reduce during behavioural treatment for related phobic problems.

Two patients suffering from long-standing psychogenic nausea were treated by paradoxical intention and exposure in vivo within an A–BC–B–BC single case experimental design. Each received six treatment sessions. At the six month follow-up, both patients had improved substantially. Contrary to what was expected, paradoxical intention produced adverse outcome; both patients because nauseous and even vomited a few times while practicing the technique. Exposure in vivo gave better results.

Paradoxical instructions were presented to a 13-year-old male client presenting with urinary frequency associated with school attendance. This resulted in sudden change in frequency behaviour which was maintained at follow-up. This case study represents the first report of the application of paradoxical intention to the problem of urinary frequency, and an explanation of the treatment success is offered.