In recent years, I have become increasingly interested in the question of self-initiated behavior change or the process by which individuals come to change their own behavior without the assistance of external treatment programs or formal intervention techniques. Based on a preliminary study of New Year's Resolutions as a framework within which to study self-initiated change (Marlatt and Kaplan, 1972), my interests have recently focused on addictive behaviors as an arena of investigation. Specifically, I am interested in studying the process of self-initiated change in individuals who attempt to modify or discontinue their use of alcohol and tobacco.

A case of depression related to justifiable homicide was successfully treated with a combination of imaginal exposure and cognitive restructuring. No previous report on comparable cases has been found in the behavior therapy literature.

The review evaluates the contribution which behaviour modification has made to the outstanding behavioural problems in dentistry: the treatment and management of the fear of routine conservation; the prevention of tooth and gum disease; the management of acute operative pain and chronic facial pain.

Investigations of dental fear and operative pain have been limited perhaps too much to patients, especially children, who attend for dental treatment. Behaviour modification has yet to help adequately those patients who avoid dentists and who may be the most acutely afraid and the most intolerant of dentistry. More adequate contributions here could be made if behavioural sciences were much more satisfactorily taught in dental undergraduate and postgraduate curricula than at present.

Useful contributions to preventive dentistry have already been made. The successful treatment of chronic facial pain will have to depend, at least in part, on a more adequate understanding of the psychophysiological mechanisms of the complaint. The nature of the placebo effect in treatment here also needs to be more thoroughly understood.

Behaviour therapists are using psychophysiological measures to an increasing extent for evaluation of treatment outcome. The main areas of use which are discussed here comprise measures and concepts of treatment of phobic anxiety and clinical application of biofeedback procedures. Finally, a brief summary of measures of sexual arousal is given at the end.

Recently a number of studies have reported successfully reducing seizure frequency by interrupting preseizure behaviour and by manipulating the consequences of a seizure. A small research project was set up to overcome some of the methodological problems of earlier studies and to evaluate such a treatment approach with four children. Treatment involved helping the children to develop means of controlling their seizures, and included a system of rewards for seizure-free periods so as to motivate the children to use their method of control. The results indicated that the treatment was successful in two out of four children. On the basis of these results some suggestions as to the mechanisms involved and the place of such an approach in the management of epilepsy are offered.

A 1-year training programme carried out in a group home for mentally handicapped adults is described. A system of goal-planning was used, so that individual goals could be regularly set for clients and their progress monitored. Choice of goals was governed by an attempt to encourage clients to become more independent and more involved with the local community. The success of the training programme is described and the usefulness of the goal-planning procedure is discussed. Implications for residential care services are also briefly considered.

The effectiveness of instructional training and response cost procedures in reducing the frequency of performance of a range of inappropriate behaviours in a group of nine long-term schizophrenic patients was examined in three distinct settings. Instructional training was found to be generally effective in controlling inappropriate behaviour. The effects of a combined instructional training and response cost procedure in further reducing the level of performance of inappropriate behaviour were confined to a small sub-group of patients and were only demonstrated in one specific setting.

Issues relating to the systematic nature of the instructional training procedure, to maintenance of change and to the role of response cost are discussed.