The progressive development of vocal responses in a 72-year-old male schizophrenic patient with a history of 48 years of complete mutism is described. The emergence of recognizable words and phrases is closely linked to the application of a range of behaviour modification procedures. The programming of generalization of treatment effects across individuals and across settings is also described.

Stimuli related to blood, injury and illness (BII) evoke a unique psychophysiological response, with signs of both sympathetic and parasympathetic arousal. Fainting, which occurs commonly in BII phobias, may represent the extreme of this reponse pattern. Data from the assessment and cognitive–behavioural treatment of a BII phobic subject are presented. At assessment the patient showed a massive bradycardia and near loss of consciousness on exposure to blood. This responded rapidly to treatment, although with some desynchrony between subjective and autonomic responses.

This paper describes in detail the treatment of a 6-year-old elective mute who had not spoken either at playgroup or school since the age of 3½ years. Treatment was carried out in school using an approach which combined both stimulus fading and positive reinforcement. At the end of a 7-month treatment period she was able to read aloud in class, convey messages and converse spontaneously. This behaviour was still being maintained 9 months after treatment ended.

Correlations were evaluated between personality factors, as measured by the EPI, and treatment outcome in obsessional–compulsive patients. The results suggest that extraverts have a slightly better outcome than introverts when treatment is carried out with a time-limit. After treatment to criterion extraversion failed to correlate with outcome. The Neuroticism scale (N) correlated with assessment variables before treatment as well as after. There was, however, an indication that high N scores were predictive of elevated anxiety ratings after treatment. None of the results applied to the sub-group taking clomipramine at the time of assessment.

The patient was an 18-year-old girl with a 2-year history of incapacitating Obsessive–compulsive avoidance behaviour for a severe germ phobia. Previous in-patient admissions had failed to produce any improvement. There were no staff in the hospital where she was admitted with any expertise in behaviour therapy so the author was called in as an outside consultant to advise on possible treatment.

A full assessment was made of the patient and the basic behavioural ideas of “modelling”, “flooding” and “avoidance behaviours” were introduced to the entire ward staff. It was decided to employ the ward sisters as the main therapists who were to act as “models”. Target behaviours for change were selected with the patient and baselines obtained before active treatment commenced. Target behaviours were handwashing, time spent in toilet, amount of toilet paper used, rituals before, during, and after showering. In addition, a “germ contamination” hierarchy was constructed. By the 18th week of in-patient treatment, all target behaviours, except going to the toilet to defecate, were under control. This latter behaviour eventually responded well several months later when she was no longer an in-patient. At 2-year follow-up, this girl was entirely free of all “germ” phobias and the associated obsessional avoidance and decontamination rituals.

A therapeutic method (behavioural casework) based upon behaviour modification and self-help principles, is described with regard to incontinence and conduct problems, both being categories of social problems which loom large in the consciousness of clinical psychologists, psychiatrists and social workers. Procedures as used in the clinical agency, but more particularly in the natural home setting, are detailed and the results (which are very encouraging) tabulated.