Following a disputed reviewof a paper submitted to this journal the present paper seeks to raise the profile of some of the issuesinvolved when the research community engages with vulnerable people. The paper is unashamedly polemical. Itargues that this is a dangerous time for vulnerable people and that current protections are inadequate. Thepaper suggests the need to re-evaluate the whole relationship between the scientific community and vulnerablepeople but also tries to identify some practical and immediate improvements that could be made.

There would be broad agreement with the need to address the issues put forward by Clements, Rapley and Cummins amongst service providers and researchers in learning disability. However, these authors' presentation of their arguments may well unnecessarily antagonize both groups. Additionally, it is suggested, the authors fail to identify the different paradigmatic bases of their proposals and thereby miss the opportunity to air genuine ethical dilemmas in learning disability research.

In this response to the commentary on our original article (Clements, Rapley, & Cummins, 1999), we examine the rhetoric of the commentary as well as some of the substantive issues raised. Although there are areas of agreement we challenge some of the views put forward in the commentary, particularly those related to the institutional power of ‘‘science’’, the questions of accountability and the involvement of vulnerable people in research decision making. We argue strongly for action now to increase the checks and balances in the system and to promote more vigorously examples of good practice.

Traditional models of the relationship between cognition and emotion have typically presented the relationship between cognition and emotion as a single level of sequential processes. However, a number of more recent models have argued to the contrary that the relationship is complex and has to be modelled by multi-level processing systems. One such model, the SPAARS approach (Power & Dalgleish, 1997), is summarized, in particular, in relation to clinical theory and practice in the cognitive behaviour therapies. For example, the proposal in SPAARS that there are two parallel routes to the production of emotion has a number of interesting clinical consequences. Highlights are presented of what some of these consequences might be, and a number of recommendations are made for clinical practice.

Eczema isa skin condition with a multifaceted aetiology that includes both psychological and physiological components.A number of studies have indicated that cognitive-behavioural techniques (e.g. relaxation) are effective inthe treatment of atopic eczema. However, it remains unclear from the literature whether different relaxationtechniques have comparable treatment effects. The current study compared the efficacy of a single relaxationsession with an imagery component with that of a comparable relaxation session without the imagery component.Eczema patients (n=9) who participated in relaxation with imagery reported significantly greaterreductions in state anxiety and subjective ratings of itchiness and significantly greater increases in mentalrelaxation levels than eczema patients (n=9) who participated in relaxation without the imagerycomponent. No group differences were found on changes in state anger. These results suggest that relaxationwith an imagery component may be more effective than relaxation without an imagery component in lowering stateanxiety levels and itchy sensations of atopic eczema patients.

By means of a single case study, the effects of redirectingattention above exposure only on fear of blushing, avoidance, and idiosyncratic dysfunctional beliefs weretested. A social phobic patient with fear of blushing as the predominant complaint received sessions of TaskConcentration Training (TCT) and Exposure in Vivo (EXP) alternately, after a steady baseline had beenestablished. The treatment consisted of 14 individual sessions. Assessments were held before and afterbaseline, after treatment, after 4 weeks follow-up, and after 1-year follow-up. Continuous measurements wereheld throughout the treatment in order to measure the differential effects of TCT and EXP on fear, avoidanceand beliefs. TCT and EXP together, turned out to be an effective treatment for fear of blushing: large effectswere observed on all three outcome measurements. When differential effects are closely looked at, EXP seemedmore effective in decreasing fear of blushing. However, the patient appeared to have used TCT strategies aswell during the EXP weeks, which may have contributed to the favourable effects of EXP.

The NijmegenMotivation List 2 (NML2) is a new instrument to assess patient motivation for psychotherapy. A previous version ofthe instrument was associated with positive treatment outcome in cognitive-behaviour therapy in several studies butits psychometric properties were poor. The present study investigated the NML2’s factorial structure,psychometric properties, and predictive value for treatment outcome. The NML2 was completed by 133 outpatients.Three factors were found: preparedness, distress, and doubt. Internal consistencies and re-test reliabilities of thefactors were reasonable. The NML2 total score and preparedness were associated with proximal treatment helpfulnessand with treatment drop-out. Distress and doubt were not. These findings corroborate those found with the earlierNML version. Rather than assuming that the relationship between motivation factors and treatment outcome is mediatedby the amount or quality of treatment or homework compliance, it is proposed that motivation for treatment is thefirst step in the patient’s change process itself.

Psychiatrists, who are still performing the executive roles in many areasof mental health, make up 6.5% (N=184) of the British Association for Behavioural and CognitivePsychotherapies (BABCP) membership. Considering that there are currently 4577 practising psychiatrists in the U.K.(Consultants, Senior Registrars, Specialist Registrars, Associate Specialists and Staff grades), the above figureis put into perspective. The equivalent figure for clinical psychologists is 40.9% (N=1162) of BABCPmembership, taken from a national total of 3734 qualified professionals. Viewed in this context, the present reviewexamines the profile of cognitive therapy (CT) in British psychiatry during the last three decades. As a measure ofthis, it was decided to survey the number of articles on cognitive therapy appearing in two key psychiatricjournals widely circulated in Britain: The British Journal of Psychiatry and Current Opinion in Psychiatry.

Memory aid groups have often been usedas a method for teaching mnemonic strategies to older adults in early stages of dementia. This studydescribes the use of CBT to address unhelpful memory-related beliefs in three older men withmild/moderate dementia and associated low mood or anxiety. The members were able to participate andengage in the sessions, and changes in behaviour, cognition and affect were monitored over the courseof a 7 week group intervention. Recommendations are made for further research.