Multiple behavioral treatment in a sexually aggressive male

Multiple behavioral strategies were used in the treatment of a sexually aggressive male. Self-monitoring reduced obsessive thoughts revolving around poor social relations and sexual aggressiveness. A social skills training program was used to remedy basic skill deficits and improve heterosexual interactions. Compulsive washing and checking rituals were treated with response prevention and flooding in an inpatient setting. Treatment gains were maintained at an 8-month follow-up.     

Tripartite assessment of the effects of systematic desensitization in a multi-phobic child: An experimental analysis

A multiple baseline design was used to evaluate the effects of relaxation training and systematic desensitization in an 11-yr-old, multi-phobic child. Responses on motoric, cognitive, and physiological channels were assessed. While change was minimal during relaxation, substantial improvement was shown in motoric and cognitive systems with sequential introduction of desensitization. Changes on physiological measures were less substantial. All gains were maintained over 1, 4 and 6-month follow-up periods.     

Social skills training for chronic psychiatric patients: Rationale,research findings,and future directions

In 1969 Gordon Paul stated that “the ‘hard core’ refractory group of chronic mental patients is clearly one of the most difficult problems facing the mental health field today.”¹ Although some progress has been achieved in this area since then,^2–7 this same hard-core group of patients (most of whom bear schizophrenic diagnoses) remains a persistent challenge to mental health practitioners. A variety of pharmacologic, socioenvironmental, and behavioral approaches (primarily the token economy) have been applied to this group of chronic psychiatric patients. We will very briefly examine the major contributions and limitations of each approach.     

Social skills training and endogenous depression

The clinical response to social skills training was studied in four women with definite endogenous depression (melancholia) to ascertain if a behavioral intervention could be effective with more severe and pervasive affective syndromes. Three of four patients responded to social skills training, although both patients available for longitudinal follow-up relapsed within 24 months post-treatment. Implications for research and practice are discussed.     

Poor peer interactions and social isolation: a case report of successful in vivo social skills training on a child psychiatric inpatient unit

The effects of social skills training comprising didactic instructions, coaching, modeling, feedback and reinforcement were examined in a child diagnosed Conduct Disorder and Attention Deficit Disorder in whom social isolation and poor peer interactions were prominent features. Treatment was implemented in the specific settings in which deficient social performance was noted using a multiple baseline design. Application of social skills training led to increased rates of appropriate interactions with peers and decreased rates of playing alone. In addition, pre- and posttreatment scores on the Child Behavior Checklist and School Behavior Checklist showed significantly decreased dysfunctional behaviors after training. Follow-up contact 1 and 12 months following discharge indicated that the child continued to socialize more with peers and to show improved adjustment.     

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.     

Multicomponent parental treatment of firesetting in a six year old boy

The case is presented of a 6-yr-old developmentally-disabled boy who was referred for the treatment of home firesetting behavior. The mother was trained to implement an intervention program consisting of negative practice with corrective consequences and token reinforcement in order to satiate and teach proper control of the behavior. This intervention was associated with the elimination of the firesetting behavior and suppression of another problem behavior, namely, fighting with the sister. Both of these behavioral improvements were maintained at 15-month follow-up. The benefits of multicomponent behavioral interventions and change agents in the natural environment are discussed.     

Treatment of phobias in a hospitalized child

A 12-year-old girl, hospitalized on a psychiatric intensive care unit, was treated for phobias of school and unfamiliar males. Treatment focused on decreasing several avoidance responses and increasing prosocial approach responses. Treatment consisted of instructions, performance feedback, participant modeling and social reinforcement. Marked changes were evident when treatment was introduced in a multiple-baseline design across several phobic and prosocial behaviors. Treatment effects generalized beyond the persons and situations included in training, were reflected in overall global ratings by persons unfamiliar with the treatment, and were maintained up to a 7-week follow-up when the child returned to the hospital for reassessment. Contact with the child 21 weeks after discharge indicated that the gains were reflected in school attendance and social interaction in everyday situations.     

The token economy in day hospital settings: Contingency management or information feedback

The token economy was evaluated as a contingency management system with chronic psychiatric patients in a day hospital setting. The hospital population was considered an N of 1, and the results were evaluated in a single case experimental design. Patients' performance in the token economy remained essentially the same whether the contingencies were in effect or not. A self-report questionnaire administered in phase 3 indicated that most patients viewed points earned as indicating how well they were doing in the program as opposed to allowing them to purchase various rewards. The token economy as a feedback system in a day hospital was discussed.     

Elimination of nocturnal headbanging in a normal seven-year-old girl using overcorrection plus rewards

An overcorrection procedure and rewards were implemented to eliminate nocturnal headbanging in a normal 7-yr-old girl. The treatment procedure involved immediate detection of headbanging by an alarm activated by a movement-sensitive switch attached to the child's bed headboard. The overcorrection procedure consisted of practicing intensively the correct form of the relevant behavior (positive practice) and applying a lotion to the irritated area of the scalp (restitution). Rewards were also made contingent upon the absence of headbanging. These procedures resulted in an immediate reduction and eventual total elimination of headbanging. Three- and six-month follow-up assessments showed that headbanging no longer occurred.     

Paradoxical interventions in behavioral medicine

This article discusses the current and potential use of paradoxical interventions in behavioral medicine. Paradoxical interventions are considered to be of two types: intra-individual and interpersonal. Treatment indications differ for the two types of interventions. Intraindividual paradoxical interventions have been successful in the treatment of insomnia, psychogenic urinary retention and constipation. Interpersonal paradoxical interventions have been subjected to less empirical research, but have been useful in the treatment of anorexia nervosa and in family based interventions where medical patients maladaptively cope with their rehabilitation. Paradoxical procedures are also used in the treatment of sexual dysfunction and may be of value in pain management. Further possible applications as well as limitations of paradoxical interventions in behavioral medicine are discussed.     

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.     

Restitution and positive practice overcorrection in reducing aggressive-disruptive behavior: A long-term follow-up

Few overcorrection studies have reported long-term follow-up data. Those that have have found mixed results and have investigated either encopretic or self-stimulatory behavior. Long-term follow-up in the reduction of aggressive-disruptive behavior has not been reported. The present investigation used combined restitution and positive practice overcorrection to reduce paper-tearing in a single subject design. Follow-up data, 18 months after treatment, indicated continued response suppression. Issues related to teaching socially appropriate behaviors as part of overcorrection procedures were discussed.     

Evaluation of depression in a general hospital: utility and limitations of the dexamethasone suppression test

Use of the DST was studied in medically hospitalized, depressed patients. Although complicating medical factors necessarily excluded nearly 60% of referrals, post-dexamethasone plasma cortisol values were significantly higher in 14 major depressives appropriate for the DST as compared to 12 patients with milder, subsyndromal depressive conditions. Using a plasma cortisol criterion of greater than 7 micrograms/dl, the DST identified major depression with 57% sensitivity and 92% specificity in this subsample (p less than 0.005). While limited by a high exclusion rate, the DST may be useful for confirmation of major depression in carefully screened general hospital patients. Implications for research and practice are discussed.     

Treatment of stereotyped hair-pulling with overcorrection: A case study with long term follow-up

The present study reports the successful use of a positive practice overcorrection procedure for reducing sterotyped hair-pulling in a 7$\text{1}\text{2}$-yr-old severely mentally retarded girl. This procedure was implemented after the unsuccessful use of a response prevention “treatment” by her parents. In addition, a verbal warning procedure was used to maintain the near-zero rate of hair-pulling achieved through overcorrection. Follow-up data for 1 year were reported.