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increase in activities, diary keeping, anxiety management techniques such as relaxation and distraction) and cognitive methods (explanation and discussion of underlying beliefs and misconceptions) (Hawton, K., Salkovskis, P., Kirk, J., and Clark, D.M. Cognitive behaviour therapy for psychiatric problems, Oxford: Oxford University Press, 1990). Specialist treatment is often not as easily available as it might be and waiting lists are usually long. Phobic anxiety about travel has attracted little attention until recently and many psychologists have relatively little experience of this particular type of phobic anxiety.

²⁶It is valuable to treat any associated depressive disorder. There have been a number of evaluations of the treatment of Post-Traumatic Stress Disorder, usually with mixed populations of trauma victims with long histories (Foa, E.B. and Meadows, E.A. Psychological treatments for post`traumatic stress disorder: a critical review. Annu.Rev.Psychol. 48:449-480, 1997; Shalev, A.Y., Bonne, O., and Eth, S. Treatment of post traumatic stress disorder: a review. Psychosom Med 58(2):165-182, 1996). There is good clinical evidence that cognitive behavioural treatment is effective following road accident injury but there has, as yet, been no satisfactory trial. There are usually long waiting-lists for treatment of PTSD and few clinical psychologists have much experience with road accident victims.

²⁷ At a relatively early stage following trauma a sympathetic but positive approach to the treatment of pain, which provides an explanation and simple behavioural techniques for increasing activity alongside physical rehabilitation, can be helpful. Concentration on physical techniques and lack of attention to the psychological factors can be harmful. Established pain syndromes are often treated in specialised pain clinics. It is a very considerable advantage if this clinic has an approach which combines psychological and physical methods and where there is easy access to specialised psychological assessment and treatment. Unfortunately, many clinics do not have the relevant psychological expertise. Very persistent and severe pain requires skilled management in a specialist centre. A variety of chronic pain programmes have been described; all combine a variety of treatment methods and aim to prescribe and agree individualised programmes with patients and their families (Main, C.J. and Benjamin, S. Psycholoical treatment and the health care system: the chaotic case of back pain. Is there a need for a paradigm shift? In: Treatment of Functional Somatic Symptoms, edited by Mayou, R., Bass,