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Objective: Cognitive-behavioural therapy (CBT) is effective for the treatment of anxiety and related disorders (ARDs). Despite this, the use of best-practice CBT in clinical practice is low. While training and assessment strategies have been developed to improve this science-practice gap, both within the educational and clinical training space, many of the assessment techniques developed to enhance the use of best practice CBT remain impractical to use in busy training settings and are prone to bias. Method: The current study presents a preliminary evaluation of the CBT Decision-Making Questionnaire for Anxiety and Related Disorders (CDMQ-A). The CDMQ-A contains vignettes covering seven diagnostic categories, each followed by three questions, resulting in a 21-item questionnaire designed to assess CBT decision-making in the treatment of ARDs in adult patients. A sample of expert (N = 7) (M age = 42.14; SD = 5.64; 57.1% female) and provisionally registered psychologists (N = 104) (M age = 30.76; SD = 8.32; 82.7% female) completed the measure. Results: Experts indicated that the vignettes demonstrated satisfactory face and ecological validity. Results indicated that the CDMQ-A can effectively discriminate between experts and provisionally registered psychologists with the expert sample scoring significantly higher than the provisionally registered psychologists t(10.63) = 6.9, p = .01; d = 1.74). Conclusions: Implications for training and clinical practice are discussed. KEY POINTS: What is already known about this topic: Cognitive-behavioral therapy is effective for the treatment of anxiety and related disorders. Despite evidence, the use of cognitive-behavioral therapy in clinical practice is low. Techniques available to assess and enhance the use of cognitive-behavioral therapy remain impractical to use in busy training settings and are prone to bias. What this topic adds: The current study presents a preliminary evaluation of the CBT Decision Making Questionnaire for Anxiety and Related Disorders. Results indicated that the questionnaire can effectively discriminate between experts and provisionally registered psychologists. The development and use of such tools have the potential to have significant implications for the dissemination and implementation of evidence-based practice, particularly within busy educational settings.

"This paper explores the issues of balancing freedom and privacy rights with security. It also acts as a primer for debate about related government responsibilities and explains why the security rights dilemma-or how the threat of terrorism-may suspend the rights of Canadian citizens. Specific attention is paid to communication-related rights such as privacy and how the threat of terrorism allows due process and other checks and balances systems to be bypassed through various intelligence practices. This paper will identifY why risk appears to trump rights in the current security environment and explain why security cannot be privileged over rights as rights are an integral part of public security. The state appears to view security as purely, or at least primarily, physical, however, if the state concentrates counterterrorist efforts on physical security, then this ignores the social aspects of security and therefore does not provide an adequate level of protection for its citizens but only advances the interests of the state. There are several ways in which the need for state security and desire to preserve democratic freedoms and values can be balanced without sacrificing one over the other, but this must begin with dialogue between the state and its citizens."--Pages 1-2.

Exposure therapy is a core component of the evidence-based treatment of anxiety, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). Despite this, many clinicians fail to use exposure therapy in clinical practice, with research highlighting a number of potential barriers. Those findings raise serious concerns regarding the effective dissemination and delivery of evidence-based treatments that in turn have a major impact on client care and cost-effectiveness of psychological interventions.The present study aims to examine barriers to the use of exposure therapy in the clinical practice of Australian psychologists treating anxiety, OCD and PTSD.One hundred registered psychologists, aged between 23 and 71 years and 84% female, participated in this study via online survey.Results suggest that the most common barriers to the use of exposure therapy include lack of confidence, negative beliefs about exposure therapy, insufficient underpinning theoretical knowledge, client-specific barriers, and logistical limitations.Future research may further examine those barriers and the components of additional training and supervision that can increase the uptake of exposure therapy, particularly in clinical areas where it is a gold standard of practice.

ObjectiveThe Social Anxiety Disorder Dimensional Scale (SAD-D) is a 10-item scale developed by the Diagnostic and Statistical Manual (Fifth Edition) Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorder work group to supplement current dichotomous approaches to assessment of Social Anxiety Disorder (SAD). The aim of the present study was to evaluate the psychometric properties of the SAD-D in an Australian community sample.MethodsTwo-hundred and ninety-one participants (72.9% female) aged 18-76 years (M =28.46; SD = 12.30) completed the study.ResultsConfirmatory factor analysis indicated support for the unidimensional structure of the SAD-D (root mean square error of approximation [RMSE] = 0.08; comparative fit index [CFI] = 0.97). The measure demonstrated strong internal consistency (α = 0.94), as well as good divergent validity. The SAD-D showed excellent test-retest reliability (intraclass correlation coefficient [ICC] = 0.93).ConclusionsOverall, the SAD-D appears to be a brief and reliable measure of SAD symptomatology. Limitations, including the use of a predominantly female convenience sample, and failure to include the mental health and background of the sample, are discussed.

Severe fear of childbirth (tokophobia; TP) is an understudied and under‐recognised phenomenon that has significant implications for maternal mental health during pregnancy, labour and delivery. The...

The Excoriation (skin‐picking disorder) dimensional scale (SPD‐D) is a new measure of excoriation skin picking disorder (SPD). The 5‐item scale was developed by the Diagnostic and Statistical Manua...

The Body Dysmorphic Disorder‐Dimensional scale (BDD‐D) is a new measure of body dysmorphic disorder (BDD) symptoms. Developed by the Diagnostic and Statistical Manual (fifth Edition) Obsessive–Comp...

Although accurate self‐assessment is essential for professional development, little is known about psychology trainees' abilities to self‐assess. The present study enhances our understanding of the...

The COVID-19 pandemic has resulted in high rates of distress in the community, and subsequently there has been an increased demand for mental health services. Cognitive behavior therapy (CBT) may play an important role in treating COVID-19 related distress; however, this treatment relies on the completion of a comprehensive assessment and appropriate individualized formulation given the heterogeneity in symptoms seen in patients presenting with COVID-19 related distress. CBT can be delivered remotely and these remote treatment approaches enhance access to treatment during the COVID-19 pandemic. This chapter provides an overview of how clinicians may modify CBT interventions for patients presenting with COVID-19 related distress in order to improve access to treatment for those in the community who may benefit from mental health services during and even after the COVID-19 pandemic.

Anxiety disorders are common and cause considerable functional impairment. Fortunately, evidence-based treatments are available, however, treatment effectiveness is often reliant on the provision of an accurate diagnosis. Accurate diagnosis requires a multi-method evidence-based assessment (EBA). Assessment techniques available to clinicians include a clinical interview, semi-structured diagnostic interview, self-report/clinician-administered rating scales and direct observation. Research demonstrates that only a small number of therapists utilize EBA, and to date this has not been investigated in an Australian sample. One hundred and two registered Australian psychologists (Mage = 40.98; SD = 12.67; 83.6% female) participated in an online study investigating assessment practices. Participants were asked to indicate EBA frequency of use and the obstacles they face to using EBA. The majority of participants (69% working with adult patients and 51% working with pediatric patients) reported partial use of EBA. Few psychologists (21% working with adult patients and 11% working with child patients) indicated complete use of EBA. Thirty-six percent of participants indicated negative beliefs about the usefulness or helpfulness of EBA. Multiple obstacles to the use of EBA were reported including concerns with the time required to complete assessment (27%), and a lack of access to assessment tools (10%). Implications for training and clinical practice are discussed.

Objective: To describe the use of psychotropic agents in a sample of subjects with obsessive–compulsive disorder (OCD), and in particular the differences associated with different OCD symptoms. Method: A total of 154 subjects participated in a study assessing OCD symptom subtypes, called the Nepean OCD Study. In addition to a comprehensive evaluation of the subjects’ OCD symptoms using the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), Vancouver Obsessive–Compulsive Inventory (VOCI), and the Sheehan Disability Scale (SDS), the subjects’ medication history was recorded. The association between symptom severity, disability, OCD symptom subtypes and the use of psychotropic agents was examined. Results: Psychotropic medication was taken by 93 (60.4%) participants. In the majority of cases ( n=55, 59.1%), selective serotonin reuptake inhibitors (SSRIs) were taken, and of the SSRIs, the most commonly used agent was escitalopram ( n=21, 22.6%). Psychotropic agents were more likely to be taken by subjects with higher Y-BOCS and SDS scores. Hoarding was associated with a lower likelihood of psychotropic use, whereas unacceptable/taboo thoughts were associated with an increased likelihood of psychotropic and antipsychotic use. Conclusion: Patients with OCD are more likely to be taking psychotropic agents if they have a more severe illness, greater disability and more prominent unacceptable/taboo thoughts.

Objective: The concept of obsessive-compulsive spectrum disorders (OCSDs) has become so influential that there are proposals to introduce it into new diagnostic classificatory systems. The aim of this paper was to assess whether rates of comorbidity and family history of OCSDs in patients with obsessive-compulsive disorder (OCD) supported this concept. Method: Comorbidity and family history were assessed in a group of participants with a primary diagnosis of OCD, using structured clinical interviews. Rates of OCSDs and other anxiety disorders (OADs), excluding OCD, were compared. Results: Of the 77 OCD participants assessed, the most prevalent comorbid conditions were OADs: generalized anxiety disorder (34.6%), specific phobia (26.9%), social phobia (21.8%) and panic disorder (19.2%). The proposed OCSDs were less frequently comorbid: tic disorder (12.8%), trichotillomania (5.1%), hypochondriasis (3.8%) and body dysmorphic disorder (BDD) (3.8%). Similar trends were observed for a family history of these disorders. No participant reported a family history of an OCSD without a family history of an OAD. Conclusions: Although the concept of OCSDs has invigorated thinking in this complex diagnostic field, these results support the current association of OCD with OADs rather than with OCSDs.

The Kessler-10 (K10) questionnaire was developed as a screening instrument for nonspecific psychological distress. Although it was validated using epidemiological samples, it is increasingly being used in clinical settings. We sought to determine whether the factor structure of the K10 as established in epidemiological samples, could be replicated in a sample of treatment seeking adults. We used confirmatory factor analysis to investigate two established models of the factor structure of the K10 in a sample of clinic attendees. Neither the single factor model of Kessler et al., Psychol Med. 2002;32:959-976, nor the multifactorial model of Brooks et al., Psychol Assess. 2006;18:62-70 fitted the data. Respecification of the Kessler et al. model to reduce item redundancy did not result in adequate fit. These findings call into question the construct validity of the K10 in treatment seeking samples, and the suitability of the scale for clinical settings may need to be reconsidered.

Background: There is little consensus as to whether agoraphobic avoidance in panic disorder is characterized by a prominence of particular symptoms and interpretations of those symptoms. Aims: We sought to clarify the relationship between symptoms and agoraphobic avoidance and to establish whether catastrophic interpretations of symptoms mediate any such relationships. Method: The Symptom Checklist 90-Revised, Agoraphobic Cognitions Questionnaire and Mobility Inventory were administered to 117 patients with panic disorder who were attending an outpatient anxiety disorders clinic. Results: Medium to large associations were found between most symptoms and agoraphobic avoidance and between particular symptoms and the corresponding symptom interpretation items. Some interpretations of symptoms were found to mediate relationships between symptoms and agoraphobic avoidance. Conclusions: These findings suggest that the catastrophic misinterpretation model of panic disorder can to some extent be invoked to explain the extent of agoraphobic avoidance, but that there may also be other pathways leading from symptoms to agoraphobia.

Attempts to explain the phenotypic heterogeneity of obsessive-compulsive disorder (OCD) have resulted in three to six OCD symptom dimensions. This study aimed to clarify the nature of these symptom dimensions using a self-report instrument (Vancouver Obsessional Compulsive Inventory [VOCI]) in addition to the clinician-rated Yale-Brown Obsessive Compulsive Scale-Symptom Checklist (YBOCS-SC). Participants (N = 154) were recruited to a study designed to specifically assess OCD symptom dimensions. Symptoms assessed via the YBOCS-SC and the VOCI were subjected to principal components analysis (PCA). Linear regression was used to assess therelationship between the YBOCS-SC-derived symptom dimensions and the VOCI symptom subscales. PCA of the YBOCS-SC and the VOCI revealed five OCD symptom dimensions that explained 68% and 60% of the variance, respectively. The results also supported a distinction between the doubt/checking symptom dimension and the unacceptable/taboo thoughts dimension that includes mental rituals. The YBOCS-SC-derived symptom components were predicted by their respective VOCI symptom subscale scores. Copyright © 2013 by Lippincott Williams & Wilkins.

Recent developments in the provision and funding of industry training in New Zealand have provided substantial challenges for Industry Training Organisations. This article focuses upon the role that they are expected to play in supporting the Labour-led Coalition’s Economic Transformation (ET) agenda, and explores some of the challenges created. A major aim of the ET agenda is to produce globally competitive firms by better directing the government investment in education and training and in research, science and technology. In this context, Industry Training Organisations are expected to play an increasingly active role in driving the government’s investment in industry training. This article considers some of the barriers and challenges they face in meeting these new government expectations.

This study aimed to examine interpersonal reassurance seeking (IRS) in obsessive-compulsive disorder (OCD) and the relationship between IRS and checking compulsions. One hundred and forty adults with OCD underwent a comprehensive assessment, which included obtaining information on seeking reassurance from others because of their obsessions. Sixty-seven (47.9%) participants reported IRS. They exhibited more psychopathology than participants without IRS, tended to have a greater overall severity of OCD and were far more likely to have checking compulsions. Participants with IRS also had more severe obsessions, suggesting that IRS plays a role as an additional coping strategy when obsessions are more prominent. The severity of obsessions and the absence of obsessions about a need to collect and keep objects were independent predictors of IRS, whereas the presence of obsessions about unintentional harm and not being married or in a de facto relationship independently predicted checking compulsions. Although a close relationship exists between IRS and checking compulsions, these results suggest important differences, with implications for understanding the factors that contribute to IRS and checking compulsions. © 2012 Elsevier Ireland Ltd.

Objectives: There are ongoing uncertainties in the relationship between obsessive–compulsive disorder (OCD) and obsessive–compulsive personality disorder (OCPD). This study aimed to test the proposition that OCPD may be a marker of severity of OCD by comparing groups of OCD individuals with and without OCPD on a number of variables. Method: A total of 148 adults with a principal diagnosis of OCD were administered the Mini International Neuropsychiatric Interview, Yale–Brown Obsessive–Compulsive Scale, Sheehan Disability Scale, Vancouver Obsessional Compulsive Inventory and Symptom Checklist 90-Revised. Participants with a DSM-IV diagnosis of OCPD were compared with those without OCPD. Results: Some 70 (47.3%) participants were diagnosed with OCPD. The groups of participants with and without OCPD did not differ significantly with respect to any of the demographic variables, clinician-rated severity of OCD, levels of disability and mean age of onset of OCD. All self-rated OCD symptom dimensions except for contamination and checking were significantly more prominent in participants with OCPD, as were all self-rated dimensions of psychopathology. Participants with OCPD had significantly more frequent hoarding compulsions and obsessions involving a need to collect and keep objects. Of Axis I disorders, only panic disorder was significantly more frequent in participants with OCPD than in those without OCPD. Conclusions: A high frequency of OCPD among individuals with OCD suggests a strong, although not necessarily a unique, relationship between the two conditions. This finding may also be a consequence of the blurring of the boundary between OCD and OCPD by postulating that hoarding and hoarding-like behaviours characterise both disorders. Results of this study do not support the notion that OCD with OCPD is a marker of clinician-rated severity of OCD. However, individuals with OCPD had more prominent OCD symptoms, they were more distressed and exhibited various other psychopathological phenomena more intensely, which is likely to complicate their treatment.

Background: In the quest to unravel the heterogeneity of obsessive–compulsive disorder (OCD), an increasing number of factor analytic studies are recognising unacceptable/taboo thoughts as one of the symptom dimensions of OCD. Aims: This study aims to examine the characteristics associated with unacceptable/taboo thoughts. Methods: Using the Yale–Brown Obsessive–Compulsive Scale Symptom Checklist (YBOCS-SC) with 154 individuals with OCD, obsessive–compulsive symptoms were subjected to principal components analysis. The characteristics associated with the resulting symptom dimensions were then assessed using logistic and linear regression techniques. Results: Unacceptable/taboo thoughts comprised of sexual, religious and impulsive aggressive obsessions, and mental rituals. Higher scores on an unacceptable/taboo thoughts symptom dimension were predicted by higher Y-BOCS obsession subscores, Y-BOCS time preoccupied by obsessions scores, Y-BOCS distress due to obsessions scores, importance of control of thought ratings, male gender, and having had treatment prior to entering into the study. Unacceptable/taboo thoughts were also predicted by greater levels of hostility, and a past history of non-alcohol substance dependence. Conclusions: An unacceptable/taboo thought symptom dimension of OCD is supported by a unique set of associated characteristics that should be considered in the assessment and treatment of individuals with these symptoms.

Objectives: Avoidance in obsessive–compulsive disorder (OCD) has been neglected by research. This study aimed (i) to collect information on the nature and frequency of avoidance in people with OCD and ascertain the types of obsessions related to avoidance; (ii) compare OCD individuals with and without avoidance, and (iii) determine predictors of avoidance in people with OCD. Method: A total of 124 OCD adults underwent a comprehensive assessment. Participants were asked whether they engaged in any avoidance behaviour because of their OCD, and the nature and number of instances of such avoidance were recorded. The instances of avoidance were grouped according to the type of obsession and compulsion that they were related to. Results: A total of 74 (59.7%) participants reported OCD-related avoidance. Avoidance was most commonly related to contamination obsessions. Almost 80% of all contamination obsessions and more than 50% of all aggressive obsessions were associated with avoidance, and contamination obsessions were significantly more common among the participants with avoidance. In contrast, very few obsessions about a need to collect and keep objects and obsessions about a need for ordering, arranging and doing things right or in an exact way were associated with avoidance; these types of obsessions were also significantly more common among the participants without avoidance. The strongest predictor of avoidance was the presence of contamination obsessions. Participants with avoidance had a significantly more severe OCD than those without avoidance. Conclusions: Avoidance is common in OCD, and it is particularly frequently associated with contamination obsessions. There is a weak link between avoidance and hoarding and between avoidance and ordering/arranging/symmetry obsessions and compulsions. These results, along with the finding that OCD with avoidance is a more severe illness, have implications for the future diagnostic criteria, description, subtyping and treatment of OCD and for its relationship with other anxiety disorders.

Objectives: The key function of compulsions in obsessive–compulsive disorder (OCD) is to alleviate anxiety or distress caused by the obsessions, but compulsions may also have other functions. The main aim of this study was to systematically ascertain what motivates individuals with OCD to perform compulsions. Method: A total of 108 adults with OCD were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Functions of Compulsions Interview. The latter instrument elicits the functions of identified compulsions. Results: The functions of 218 compulsions were identified. The mean number of functions per compulsion in the whole sample was 2.94 and the vast majority of compulsions (85.3%) were performed for more than one reason. The total number of functions of compulsions endorsed for the three main compulsions correlated with Y-BOCS total scores (r = 0.37, p < 0.001). Compulsions were most frequently performed automatically and to decrease distress or anxiety, but there was substantial variation, depending on the type of compulsion. Hoarding was often performed for reasons not related to any other compulsion (involving a perceived need for collected objects), whereas ordering/symmetry/repeating compulsions were frequently performed to achieve a ‘just right’ feeling. Checking was frequently performed because of the belief that something bad or unpleasant would happen if one failed to check; washing/cleaning compulsions were most frequently performed to decrease distress or anxiety and automatically, and mental compulsions were performed automatically far more often than for other reasons. Conclusions: The majority of compulsions have more than one function and they are often performed automatically. The finding of different functions of compulsions in different types of compulsions provides some support to the subtyping of OCD on the basis of obsessions and compulsions. Identifying functions of compulsions allows better understanding of the functional relationship between obsessions and compulsions, which may have implications for cognitive-behavioural therapy of OCD.

Background and Objectives Findings from non-clinical samples suggest that disgust propensity is associated with contamination concerns in obsessive–compulsive disorder (OCD). However, studies of clinical samples have yielded conflicting results. We investigated the relationship between disgust propensity and OCD symptoms in a clinical sample and examined whether changes in disgust propensity are associated with changes in OCD symptoms. Methods One hundred and nine OCD participants completed measures of disgust propensity and OCD symptoms. Sixty of these underwent a six-month follow-up assessment. Results At the baseline assessment, disgust propensity was associated with all OCD symptom dimensions except hoarding. Changes in overall disgust propensity between baseline and the six-month follow-up assessment were associated with changes in overall self-reported OCD symptoms but not with changes in contamination-based OCD symptoms or changes in interviewer-assessed OCD symptoms. Limitations There was substantial participant attrition between the baseline and follow-up assessments. Conclusions Our study is the first to investigate prospective relationships between disgust propensity and OCD across a six-month interval. Our findings suggest that if there is an association between changes in disgust propensity and changes in contamination-based OCD symptoms its magnitude is likely to be small.

Background: The question of whether certain anxiety disorders are especially related to a cognitive style characterized by an exaggerated perception of threat and appraisal of the future as excessively unpredictable (general anxiety-prone cognitive style) remains open. Objectives: This study aimed to compare patients with generalized social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder with agoraphobia (PDA), and panic disorder without agoraphobia (PD) in terms of the levels of general anxiety-prone cognitive style when the severity of general distress and psychopathology is controlled for and to ascertain whether a co-occurring depressive disorder contributes substantially to the levels of this cognitive style. Methods: The Anxious Thoughts and Tendencies Scale, a measure of a general anxiety-prone cognitive style, and Symptom Checklist 90 - Revised were administered to 204 patients with various anxiety disorders who attended an outpatient anxiety disorders clinic and were diagnosed based on a semistructured diagnostic interview. Results: Patients with principal diagnoses of SAD and GAD had a more prominent general anxiety-prone cognitive style than patients with principal diagnoses of PD and PDA when the severity of general distress and psychopathology was controlled for. The presence or absence of a co-occurring depressive disorder had no bearing on this finding. Conclusions: The general cognitive component characterizes SAD and GAD more than it does PD and PDA, and a co-occurring depressive disorder does not affect this finding. These results have implications for distinguishing between various anxiety disorders. © 2012 Elsevier Inc.

Improving carbohydrate intake in athletes will increase muscle glycogen storage. This in turn can improve exercise time and performance by delaying fatigue. However, planning and consuming a diet that contains 60% to 70% carbohydrate is difficult for most athletes. To develop a simple carbohydrate monitoring tool for athletes, we analyzed three sets of 3-day diet records from 17 male endurance runners over a 10-week competitive period and 9 female endurance runners over a 9-week training period. We then developed a simple carbohydrate monitoring tool. To validate the instrument, we compared each athlete’s carbohydrate intake as estimated using the instrument with the athlete’s actual carbohydrate intake from the 3-day diet records. Mean estimated percents of energy from carbohydrate using the carbohydrate monitoring tool were not significantly different from the actual mean carbohydrate intakes. Examination of individual diets showed that the estimated carbohydrate was always within 2% of the actual carbohydrate. Therefore, the instrument did a good job of estimating the percent of energy from carbohydrate in the diets of endurance runners. This instrument will provide a quick method by which the athlete can assess and improve carbohydrate intake on a daily basis without the use of daily diet records.

ObjectivesTo ascertain what motivates patients with obsessive-compulsive disorder (OCD) to perform compulsions.MethodsFifty-nine OCD patients underwent a comprehensive assessment, which included a structured interview designed to elicit one or more functions of their compulsions. Each patient was interviewed about the maximum of 3 compulsions.ResultsThe functions of 138 compulsions were identified, and compulsions were classified in accordance with OCD symptom subtypes as washing/cleaning (n=35), checking (n=33), mental/covert (n=23), ordering/symmetry (n=17), hoarding (n=10), and miscellaneous (n=20). Compulsions were most frequently performed to decrease distress or anxiety (n=87, 63%) or automatically, without patients thinking why they were doing it (n=87, 63%). However, the reasons for performing compulsions varied significantly, depending on the OCD subtype. In comparison with patients from other subtypes, those with checking compulsions were more likely to perform them because they believed something bad would happen if they failed to do so, patients with washing/cleaning compulsions were more likely to perform them to alleviate the feeling of disgust, and patients with mental and ordering/symmetry compulsions were more likely to perform them to achieve a “just right” feeling.ConclusionsIdentifying functions of compulsions improves understanding of the psychopathology of OCD and has important treatment implications. Cognitive-behaviour treatment approaches differ in accordance with the reasons for performing compulsions: exposure and response prevention tends to achieve better results when compulsions are driven by a need to decrease distress, anxiety or the feeling of disgust, whereas cognitive techniques may be more useful when compulsions are performed for other reasons.

When we began the Eastern Michigan University opportunity program for underprepared stu dents, we encountered weak academic skills and weak motivation, and we faced the baffling question of where to begin to remedy all that needed remedy. Very early, we decided to emphasize the improvement of the stu dents' reading and writing skills. We reasoned that this would be the students' most direct way to academic competence, self-integration, and firm purpose.