Information and opinions about behavior modification

Previous research has suggested that the general population views behavior modification as an “appropriate” therapy for certain problems but it has not assured that these attitudes are based on an accurate conceptualization of behavior modification. In the present investigation, students and non-psychology faculty were assessed regarding their knowledge about and their attitudes toward several aspects of behavior modification. Attitudes toward behavior modification generally were favorable. Although greater knowledge as measured by a very simple task was associated with more favorable attitudes toward behavior modification, the overall level of information was very low. The significance of positive attitudes based on distorted information was discussed and concerns for behavioral clinicians were highlighted.     

Behavioral correlates of individual differences in blood pressure reactivity

To examine the relationship between (a) individual differences in blood pressure reactivity and (b) behavioral characteristics associated with the Type A, coronary-prone behavior pattern (specifically, verbal response style and the perception of time), 45 subjects (male attorneys) were instructed to perform a frustrating cognitive task while measures of systolic and diastolic blood pressure (SBP, DBP) and pulse pressure (PP) were obtained and subjects' verbal responses recorded on audio tape. It was predicted that subjects showing the largest task-related blood pressure elevations (reactors) would respond to test items verbally in a more “Type A” fashion (i.e. with greater speed, volume and emphasis) and estimate the task period to have lasted longer (i.e. experienced time passing more rapidly) than physiologically less reactive subjects (nonreactors). Auditors' ratings indicated that PP-reactors responded with greater volume and emphasis than PP-nonreactors, and both PP- and SBP-reactors estimated task duration to have been significantly greater than did their nonreactor counterparts. While these findings support the predicted association of Type A-related behavior and blood pressure reactivity (particularly for PP), reactor and non-reactor groups did not differ on a self-report measure of the Type A behavior pattern. Finally, preliminary data regarding the generalizability of differences in reactivity to casual blood pressure measurements obtained during subjects' ordinary activities indicated that SBP-reactors experienced higher peak casual SBPs and greater SBP variability over a six-week interval than did SBP-nonreactors.     

The use of treatment contracts to reduce medicaid costs of a difficult patient

This paper discusses the use of treatment contracts to manage the medical system use by a patient who made frequent and unnecessary outpatient and emergency room visits. The patient's progress was monitored, using a computerized Medicaid billing system which provided monthly summaries of the patient's outpatient and emergency room visits, the costs of these services and the number of taxi rides per month. The costs of the treatment program were estimated from the data and mental health center records. Computerized Medicaid systems have potential usefulness as outcome measures for behavioral treatment programs.     

A novel approach to assessment in the treatment of childhood trichotillomania

The present study describes the successful treatment of a 9-year-old girl with trichotillomania. Intervention involved (1) praising attractive hair and ignoring hair loss, (2) education in hair hygiene, (3) response prevention for night-time hair pulling, and (4) a variable schedule of monetary rewards for criterion hair growth. Progress was assessed by counting hairs in random scalp areas and measuring bald areas. Hair growth increased from three hairs per area sampled at baseline to such dense hair growth that individual hairs could not be counted and no bald spots were noted. Results maintained at 2, 6 and 10 months follow-up.     

Overcorrection: A further evaluation of restitution and positive practice

Foxx and Azrin's overcorrection technique employs two distinct procedures, restitution and positive practice, for treating inappropriate disruptive behaviors. While the efficacy of overcorrection when both procedures are used concurrently has been documented, little research has demonstrated the relative effectiveness of each procedure when used alone. The purpose of the present study was to compare restitution and positive practice in the treatment of 20 young children exhibiting highly resistant and disruptive behavior. Results indicated that both procedures rapidly eliminated the inappropriate behaviors. Mean decreases in inappropriate behaviors from baseline to follow-up were 89% for restitution and 84% for positive practice. It was demonstrated that each procedure was effective with numerous problem behaviors. Self-reports of children indicated that they preferred overcorrection compared to other forms of punishment.     

Teaching a six-year-old girl to swallow pills

The present study used a modeling and shaping procedure to teach a 6-year-old girl to take pills. During one 45-min session, following instruction and modeling by the experimenter, the subject was presented candy hearts of increasing size, with reinforcers provided for successful swallowing. Maintenance and generalization of treatment effects were reported at home and at school.     

The significance of treatment effects across several independent studies

Standardized means can be generated from the t, F or x² statistic used to test the significance of treatment efffects in each of several independent studies. An unweighted means ANOVA, calculated from the standardized means, provides tests of significance for the treatment main effect across studies and for the differences in magnitudes of the treatment effects between studies. The protection against Type I errors (false positive conclusions) afforded by the standardized means ANOVA is evaluated in a series of Monte Carlo simulations involving both equal and unequal sample sizes and error variances. A detailed illustration of the method is provided. The combining of information from multiple independent trials in clinical psychopharmacology research is illustrated with regard to problems of establishing the general equivalence of two drugs, as well as in providing a comprehensive conclusion concerning efficacy across several studies that may not appear uniformly positive.     

The use of relaxation in the treatment of self-injurious behavior

A severely self-injurious, profoundly retarded woman was taught to relax her hands and arms while still in full restraints. As relaxation was gradually learned, the restraints were gradually removed. By the end of training the subject had learned to relax when released from restraints with virtually no self-injurious behavior occuring throughout the training.     

Life events occurring in families of children with recurrent abdominal pain

Thirty children with recurrent abdominal pain (RAP) were compared to 67 behaviorally disordered (BD) children and 42 healthy children on number of life events experienced within the last 12 months and on amount of readjustment necessitated by these life events. The parents of these children were also compared on these variables as well as on a subjective rating of stress which they assigned to the life events. The results revealed that the children in the RAP and BD groups had significantly more life events and more stress associated with them than did the healthy children. However, the children in the RAP and BD groups differed in type of life events, with the RAP group more likely to have experienced life events related to illness, hospitalization, and death. There were no significant differences between the parents in the RAP group and the parents of the two comparisons groups. Due to methodological limitations of the study, caution should be exercised in drawing conclusions from these findings until such time that future research provides confirmatory data.     

Positive reinforcement and punishment in the treatment of childhood trichotillomania

A comprehensive behavioral treatment package was developed during 13 treatment sessions and was communicated to a mother of a five year old girl with a four year history of hair pulling which had resulted in almost total baldness. Treatment consisted of a variety of positive reinforcement procedures which resulted in a gradual decrease in the hair pulling behavior, and finally the use of punishment which led to a rapid decrease and virtual elimination of the problem. The child was symptom free with shoulder length hair at a 16 month follow-up. The growing literature on behavioral treatment of trichotillomania and the ethical implications of the use of punishment are reviewed.     

Habit reversal vs negative practice treatment of self-destructive oral habits (biting, chewing or licking of the lips, cheeks, tongue or palate)

Ten patients with oral habits such as biting, chewing licking, or pushing of the cheeks, lips, teeth, or palate were randomly assigned to either habit reversal treatment or to negative practice treatment. Treatment was given in a single 2-hr session. The patients receiving negative practice treatment showed a mean reduction of about 65%, those receiving the habit reversal treatment showed a mean reduction of about 99% during the 22-months of follow-up.     

The effects of response contingent parental reinforcement upon schizophrenics' learning

Forty schizophrenic and 40 non-schizophrenic male psychiatric inpatients, matched for age, intelligence, and social competence, were administered equivalent form nonsense syllable discrimination tasks under each of four conditions: an initial baseline information feedback condition, two response contingent reinforcement conditions, and a final baseline information feedback condition. Subjects of both diagnostic groups were further divided into eight groups of ten patients each. Half the groups received praise and half received censure during the response contingent conditions. In counterbalanced order, the reinforcing agent was the experimenter in one condition and a recorded voice of one of the parents in the other. Half received the mother's and half received the father's voice. Schizophrenics responded faster under experimenter than under parent reinforcement. Poor premorbid schizophrenics, making more errors than goods, responded faster under experimenter as opposed to parent reinforcement. Among non-schizophrenics, education, social competence, and I.Q. were all negatively correlated with response latency and number of errors. Among schizophrenics, the higher the I.Q., the fewer the errors and the shorter the response latency, except when such subjects were reinforced by their parents. Then no significant relationship existed. Marital status, however, was significantly related to performance, with unmarried status positively correlated with slower response to parents. All subjects responded more quickly and accurately in the final than in the first baseline condition regardless of diagnosis or interpolated reinforcement experiences. Data were interpreted as providing limited support for the social censure hypothesis of Garmezy and his colleagues, but as consistent with recent formulations concerning the schizophrenic patient in relation to his family.     

Imaginal pacing in the treatment of stuttering

This report describes a procedure which is effective for decreasing the rate of stuttered speech and for increasing the rate of fluent speech. Two boys, who stuttered severely, first paced their speech to the beat of a metronome. Over a number of sessions the metronome beat was removed and other stimuli were added, culminating in the institution of a private or imaginal beat by which speech could be paced. The boys also progressed from saying one syllable per beat to saying one word per beat. Stuttering behavior for both boys rapidly decreased in both rate and intensity as fluent speech increased.     

A 16-year follow-up of a case of severe anorexia nervosa

A 16-year follow-up of a case of extreme anorexia nervosa treated exclusively by operant conditioning techniques is presented. The present status of the patient is reviewed with respect to her eating habits, weight, physical and social activity and her general adaptation to life.     

Positive practice, overcorrection and behavior rehearsal in the treatment of three cases of encopresis

A procedure based on positive practice, overcorrection and behavior rehearsal was developed for treating encopretic children in a community mental health clinic. The procedure was easily taught to and administered by parents, emphasized maximum participation by the youths in the treatment program, maximized the use of the limited time a mental health clinic therapist has with individual clients, stressed positive and educative approaches rather than punitive ones, and was both rapid and effective in reducing encopretic behaviors. The procedure was employed with three male children aged five, seven and twelve years whose presenting problem was nonorganic encopresis. In each case, soiling was eliminated within six weeks in youths whose encopresis had persisted from two to eight years. An eighteen month follow-up indicated no further evidence of the problem behaviors.     

Behavioral treatment of depression in a prepubertal child

The present study evaluated behavioral treatment of symptoms of depression in a 10 yr-old boy. Diagnosis of the child's depression was made on the basis of DSM-III criteria. Information was obtained from separate interviews with the child and mother and from multiple assessment instruments. Ratings from several sources (mother, psychiatrist, psychologist and staff) confirmed the diagnosis. Four behaviors that characterized the child's depression were selected for intervention and included inappropriate body position, lack of eye contact, poor speech and bland affect. Treatment, evaluated in a multiple-baseline design across symptoms, consisted of the combination of instructions, modeling, role-playing and feedback. Results indicated that behaviors characteristic of childhood depression could be reliably identified and effectively treated by behavioral techniques. Treatment effects were maintained at 12-week follow-up assessment.     

The use of skills training procedures in the treatment of a child-abusive parent

Recent behavioral formulations suggest that child abuse can often be conceptualized in terms of skill deficits of the parent. In the present case study, training was used to improve an abusive parent's anger-assertion, child management, and personal problem-solving skills; deficits in all three areas were functionally related to prior episodes of violence. Treatment across these skill areas was introduced in multiple baseline fashion. The effectiveness of treatment was demonstrated by (1) assessments of assertion, child management, and problem-solving knowledge following each training session; (2) parent monitoring data on the frequency of child-related and anger problems at home throughout the intervention; (3) performance on skill generalization measures; and (4) objectively-rated parent-child interactions during pre- and post-training home observation probes.     

The simultaneous replication design: The use of a multiple baseline to establish experimental control in single group social skills treatment studies

Behavior therapists, especially those in service-oriented applied settings, are often confronted with the need to conduct social skills or assertive training in groups. While single subject multiple baseline analyses have been widely used in the research literature, there are few well-controlled group treatment evaluation design choices feasible for the behavioral clinician without ready access to large numbers of control subjects. The present paper describes a group multiple baseline-simultaneous replications treatment design which establishes experimental control within a single ongoing training group by combining group treatment with behavioral assessment of each subject following each group session. This extension of multiple baseline analysis techniques to group social skills training can prove useful for more rigorously evaluating the effectiveness of social skills interventions in many applied settings.