The problem of effective diabetes care presents new opportunities for the emerging field of health psychology. Diabetes mellitus affects nearly 10 million Americans and is one of the most common chronic health problems. The authors discuss the relevance of behavioral variables to the understanding of this disease and suggest that behavioral interventions might contribute to the treatment of diabetes by reducing the energy-mobilizing effects of the autonomic nervous system as well as by facilitating the development and maintenance of patient self-care.

The treatment of people with diabetes mellitus almost always involves an effort on the part of the health-care team to impose new patterns of behavior on their patients. Too often this behavior modification is undertaken without any specific attention to factors in the treatment regimen that may enhance or detract from patient compliance. If, however, the treatment of disease is viewed in terms of changes in both physiology and behavior, the importance of intervention aimed at either direct behavioral manipulation of physiology, or alterations of secondary behavior related to the disease and its therapy, becomes apparent. We have reviewed in this paper the current "state of the art" of both direct behavioral treatment of diabetes and techniques to enhance compliance with treatment program.

The Role of Common factors in Medicine n the summer of 1901 A. E. MacDonald, superintendent of Manhattan State Hospital, confronted a logistics problem quite unfamiliar to hospital administrators today-too many patients and too few beds. To alleviate cramped conditions created by an influx of tuberculosis admissions, about 40 patients with this disease were transferred from the main wards to two large tents that had been set up on the hospital grounds. The novelty of this arrangement generated excitement among the staff and created a desire to provide the tent residents the very best of care, nutrition, and attention. Before long, staff began to observe symptomatic improvement in many of these patients, gains that were lost in the winter when the patients were returned to quarters within the main hospital. Positive treatment outcomes were attributed to the effects of fresh air and physical environment, leading to enthusiastic efforts to construct camplike treatment settings for tuberculosis patients elsewhere, including outdoor or "tent" wards. Eventually, when the novelty of the experiment wore off and life within the tents began to mimic the monotony of the regular wards, the new environments lost their curative power (Caplan, 1969).Nearly one hundred years later, the May 12, 1997, issue of Time magazine featured a discussion of Andrew Weil's holistic medicine approach, a combination of conventional prescriptions for healthy living-exercise, diet, vitamins, stress reduction-and more controversial herbal, hypnotic, and chiropractic remedies for a variety of physical ailments

Studies which investigate the impact of treatment on subjects with singular and multiple sexual paraphilias (exhibitionism, fetishism, pedophilia, transvestism, voyeurism) are reviewed. A methodological evaluation was conducted with attention to six categories: design, subjects, therapists, treatment, time periods, and outcome measures. Subjects included sexual offenders and non-offenders. Most of the studies were single-case reports. The methodological shortcomings in the literature included the failure to control for social desirability factors, especially in the case of sex offenders, and the reliance upon verbal selfreports in the evaluation of outcome. Almost all of the studies found positive treatment effects, either immediately after treatment or at various follow-up periods. However, periodic booster treatment sessions sometimes were necessary with paraphilias of long duration. Across the paraphilias reviewed, the literature offered tentative support for the efficacy of a multiple behavioral treatment package specifically tailored to aspects of the patient's sexual arousal pattern. The elimination of variant sexual responses in conjunction with fostering appropriate, nonvariant sexual behavior is a relevant treatment strategy in some cases. Future research should use homogeneous experimental and control subjects, obtain a pre-therapy assessment of sexual and social functioning, specify treatment goals, and use multiple outcome measures. The importance of specifying subject variables for the goal of successful subjecttreatment matches is also suggested. As a step in that direction, a checklist which noted the psychological and situational correlates of the five predominant sexual paraphilias was derived from the literature.

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