A central aspect of self-management of diabetes involves patients regulating the timing and intake of dietary carbohydrates. A 20 year old female diabetic patient was taught to identify deviations from appropriate dietary self-management, and a problem solving intervention was used to train new behavior in settings associated with such deviations. Dietary behavior and blood glucose levels were monitored in a diary and electronically, and treatment effects were evaluated in a multiple baseline across settings design. Treatment resulted in clear improvement in dietary management, and a substantial gain in blood glucose control at the end of intervention. At follow-up dietary change was maintained. Long term effects on blood glucose levels were confounded by a reduction in insulin dosage between treatment and follow-up.

The effects of education and stress reduction groups for the relatives of schizophrenic patients and their perception of services available to them is presented. 76% of relatives refused invitation to groups because they were overburdened. Those attending the groups said that they found them beneficial but measurable improvements were slight. Relatives' perception of the shortfalls of the services and the difficulties faced differed from that of patients. As the majority of patients turn to their relatives for help and support, rather than approaching hospital services directly, relatives were better able to identify service shortfalls. Patients' perceived needs included employment and increased income, which are not amenable to direct hospital intervention. Relatives were able to express needs that could be addressed by services. Both patients and relatives were able to identify the main difficulties faced, though there was a difference in emphasis.

An Uncommon Casebook: The Complete Clinical Work of Milton H. EricksonWilliam Hudson O'Hanlon and Angela L. Hexum. New York and London: W.W. Norton & Co., 1991. pp. 350. £24 hardback. ISBN 0-93-70101-8 - Volume 21 Issue 2

This report describes a placebo strategy which engendered a reasonable degree of positive expectation in 10 Generalized Anxiety Disorder patients and was perceived by them as being credible, sensible and appropriate at pre- and post-therapy and at six month follow-up. The significant improvement noted on a range of measures suggests that the strategy is not inert.

The paper presents a single case study of the treatment of primary encopresis in a 6 year old boy. The boy had never had regular bowel movements, suffered from retention for periods of 4–5 days, and soiled himself when he finally passed a bowel movement. The subject was treated using behavioural and cognitive techniques, and the progress was evaluated using a single subject design. The findings revealed that the intervention succeeded in stopping the boy's soiling and retention and in his achieving regular bowel movements. Two follow-up interviews after six and twelve months demonstrated that the improvement had persisted. The results suggested that the behavioural therapy package constituted an effective means for the treatment of encopresis.

The present study investigated whether social support and family members' reactions to clients with obsessive compulsive disorder played a significant role in the follow-up outcome of an intensive behavioral treatment program. The roles OCD symptoms, moodstate, social functioning and life events were also assessed. General social support did not predict relapse, but significant others' empathy and positive interactions were associated with maintenance of gains. Negative family interactions (especially criticism and anger) and belief that clients could control their symptoms predicted relapse. Higher levels of post-treatment anxiety and depression and poorer functioning were related to negative outcome, as was distress from life events during follow-up. Results are discussed with respect to possible mechanisms of action and future research needs.

The anxiety-inhibiting properties of the prospect of vomiting were assessed and contrasted in 12 women with bulimia nervosa and an equal number of non-bulimic women. Subjects were exposed to a pleasant control scene and six food-related scenes in which they imagined eating standardized test meals with the knowledge that vomiting could or could not occur afterwards. The level of anxiety evoked by the scenes was assessed using subjective, behavioural and physiological measures. As predicted, bulimics reported that they would consume more of the meal when vomiting could occur after. No such difference was found for control subjects. However, the groups did not differ on subjective and physiological measures of anxiety. The results of the present study suggest that bulimics may utilize a hierarchy of control strategies to mediate the anxiety evoked by eating that may be amenable to cognitive-behavioural interventions.

This paper describes and evaluates the adaption of Behavioural Marital Therapy (BMT) to the needs of a couple in a secondary marriage (the husband was in his second marriage and brought three dependent children to this marriage). The couple presented with specific difficulties in negotiating parenting roles within the reconstituted family. BMT focused on promoting adaptive cognitions, affect and communication when discussing this specific issue. Evaluation used a multiple probe design assessing self-monitored stressful interactions about parenting, and daily marital satisfaction. Results showed significant reductions in the intensity and frequency of arguments from pre- to post-therapy, and increases in marital satisfaction. These gains were maintained at follow-up. Discussion focuses on future directions for adapting BMT to problems particular to secondary marriages.

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