Summary And Conclusions

Exposure therapies are the treatment of choice in adult specific phobia, social phobia, agoraphobia, and obsessive-compulsive disorder (Emmelkamp, 2004) and have also been found quite effective in phobic children (Nauta et al., 2003). Studies of the behavioural treatment of depression have come to a standstill due to the rise of cognitive therapy in this area but the lack of further research into the behavioural treatment of depression is not justified by the data. There are still a number of important issues that need to be addressed. For example, we have no idea why cognitive therapy, behavioural interventions, IPT and pharmacotherapy work equally well with depressed patients, although various researchers provide various theoretical explanations. Unfortunately, to date there is no evidence that either cognitive or behavioural theories explain the improvements achieved with these various treatment procedures.

In the area of substance abuse the interest has moved away from aversive procedures into multifaceted self-control programmes. One of the promising areas for future research is relapse prevention. The results of studies that investigated coping skills programmes to prevent relapse look promising. Another new area that looks promising is spouse-aided therapy as illustrated in the case described above.

Although behaviour therapists have been very productive in evaluating the efficacy of various techniques, relatively little attention has been devoted to the therapeutic process. It is, however, becoming increasingly clear that the quality of the therapeutic relationship may be influential in determining success or failure of behavioural therapies, although well-controlled studies in this area are rare. It is a common misconception that behaviour therapists are 'unempathic' and apply only techniques.

There are marked differences between therapy as conducted in outcome studies and therapy in clinical practice, where it is usually adapted to the individual needs of the patient. For example, clinicians emphasize the importance of the functional behaviour analysis. However, research into the value of the functional behaviour analysis is almost lacking. In a study by Emmelkamp, Bouman & Blaauw (1974) in patients with obsessive-compulsive disorder and a study by Schulte et al. (1992) in patients with phobias standardized treatment (exposure and response prevention) proved as effective as idiosyncratic treatment based on a functional behavioural analysis. It seems that the standardized treatment protocols developed over the years have not yet been beaten by an individualized behavioural treatment.

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