A rapid multi-component treatment for an obsessive-compulsive disorder

A 67-yr-old woman with a 45-yr history of obsessive-compulsive problems related to fear of contamination was treated rapidly by a multi-component intervention. Questionnaire data following treatment showed the patient to be free of obsessive-compulsive complaints, and these were corroborated by behavioral observations. Follow-up probes conducted 6, 12 and 18 months later revealed continued maintenance of treatment gains. Patient-therapist contact time totalled 6 hr, about one-third of the time employed by Marks for exposure and response prevention, indicating the cost-effectiveness of a multi-component treatment intervention.     

Treatment of obsessive-compulsive hair pulling (Trichotillomania) by behavioral and cognitive contingency manipulation

A case of trichotillomania of 11 yr duration in a 21-yr-old female was successfully treated using contingency management for both hair pulling behavior and the urge to pull hair. During treatment of approximately two months, the hair pulling behavior was associated with a mild aversive procedure and her awareness of the urge to pull hair was used as a cue to initiate hair grooming. She remains essentially symptom free of hair pulling and has a markedly reduced awareness of urges to pull her hair at 7-months follow-up.     

A comparison of two relaxation procedures for reducing cognitive and somatic anxiety

The effectiveness of two different relaxation procedures was compared in treating snake anxious people who expressed anxiety primarily in a somatic or a cognitive manner. Forty moderately snake phobic subjects were categorized as either “somatically-anxious” or “cognitively-anxious” on the basis of a questionnaire. Half of the subjects in each group were given modified progressive relaxation training, and the other half received training in Agni-Yoga for four sessions. After completion of training, approach distance, subjective fear and pulse rates were measured during a snake approach test. In addition, a snake fear scale was given to each subject prior to and after approaching the snake. The results provided tentative evidence that the two relaxation procedures produced differential effects according to whether subjects expressed anxiety somatically or cognitively.     

The use of problem solving to reduce examination and interpersonal anxiety

A 32-yr old woman was treated for examination and interpersonal anxiety by the use of systematic problem solving. Her anxiety occured because domestic difficulties prevented her from preparing for and taking examinations. This procedure was used after cognitive desensitization was unsuccessful in reducing her anxiety. The problem solving procedures provided her with skills in identifying and engaging in appropriate behaviors to reduce domestic pressures. Following treatment her anxiety attacks decreased from approximately five a day to one per week. In addition, the client was able to apply the problem solving skills to other, non-treated areas of her life.     

The use of stimulus control procedures to eliminate persistent nocturnal awakenings

A 22-yr-old male with a 6 yr history of sleep onset insomnia and frequent nocturnal awakenings was treated with relaxation training and stimulus control procedures. The stimulus control component consisted of a variety of procedures for associating sleep with the bed and non-sleeping activities with other stimuli. In addition, the client self-punished for nocturnal awakenings. The relaxation procedure, used first, reduced the time the client needed to fall asleep and several somatic complaints, but did not reduce nocturnal awakenings. The addition of the stimulus control/punishment procedures eliminated nocturnal awakenings.     

Generalization training and the transfer of prosocial behavior in delinquent adolescents

This study examines the role of generalization training in the transfer of behavior to extra-training settings. Four residents of a treatment center for delinquent adolescents participated in seven 30-min training sessions in which undergraduate students reinforced (praise and redeemable points) positive comments made to peers. For two subjects the same undergraduate trainers conducted all sessions which involved a single activity (ping-pong). For the other two subjects, new trainers and new activities were introducedduring each session. Observation in the residential home was carried out before, after, and during training. “Home” observations revealed that generalization-training subjects showed greater increases over baseline performance during training and post-training periods than constant-training subjects.     

A home-based program for a preschool behaviorally disturbed child with parents as therapists

The effects of a set of reinforcement procedures upon the “autistic” behaviors of a four-year-old girl were evaluated. The study was carried out entirely in a home setting with the mother and father as change agents. The parents were trained to use, in a semi-structured play setting, through written and verbal instructions, a treatment program consisting of positive attention and timeout. Each parent independently applied the training procedures to the child's compliance, inappropriate vocalization and noncompliance behaviors. Both multiple baseline and reversal procedures were employed to assess treatment effects. Results indicated that the parents' use of the positive attention and timeout procedures was responsible for a substantial improvement in their daughter's compliance with instructions and a marked decrease in the two inappropriate responses. Comparisons across parents indicated no marked differences in the procedures' effects on the child's behaviors.     

Flooding or systematic exposure in the treatment of extreme social withdrawal in children

Several children provided social stimuli for treating the extreme social withdrawal of two young boys, one treated by flooding, the other by systematic exposure. To assess the effectiveness of the treatment procedures, within-subject designs were used, consisting of multiple baselines across settings. The results showed that when flooding was introduced in the first setting for the first child, a dramatic increase in interaction from 0 to 60% resulted, with an accompanying decrease in self-talk from 70 to 20%. These behavioral changes did not occur in the second setting until flooding was introduced, when interaction increased form 10 to 40% and self-talk decreased from 85 to 20%. Similar results were obtained with systematic exposure in the second child. Follow-ups of 5 months in the first child and 9 months in the second indicated that the therapeutic gains were maintained. Thus, in treating anxiety-related problems in children in their natural environment either flooding or systematic exposure can be effective.     

Some laboratory paradigms for chemical aversion treatment of alcoholism

An extensive literature shows that animals can be trained to avoid a flavored substance if sickness follows consumption. These experiments parallel the chemical aversion therapy of alcoholism nearly exactly. The following suggestions are made for the improvement of this therapy. (1) Lithium appears to be the most effective agent with which to produce the sickness. (2) The alcoholic beverage (in small amounts) should actually be swallowed during treatment, not just tasted. (3) The sickness should be induced after the patient begins to drink even if the result is an appreciable delay between drinking and the peak of the sickness. (4) The patient should fast for a number of hours prior to treatment. (5) An individual treatment usually should involve only one alcoholic beverage.     

Biofeedback treatment of long-standing eye closure reactions

A 34-yr-old woman, who had a 13-yr history of being unable to keep her eyes open, was treated successfully by EMG biofeedback and relaxation training. Relaxation training reduced self-recorded eye closures at home, but failed to reduce the frequency of eye closures recorded during office treatment. Biofeedback training was used first for relaxing the frontalis muscle when her eyes were closed and later with her eyes progressively more open. Following biofeedback training she was given assertion training to increase her social contacts. At 6-month follow-up, she was able to maintain normal eye-openings, and reported having fewer interpersonal problems.     

Chronic pain and depression: a review

An interesting association has long been observed between chronic benign pain and depression. Some investigators have even suggested that chronic pain is indeed a particular form of depressive illness. A close examination of literature reveals many fundamental problems with such claims. Research in this area is generally weak and while there may be an interesting relationship between depression and chronic pain both at the psychosocial and biochemical levels, it would be a gross error to equate chronic pain with clinical depression. Chronic pain is not a primary psychiatric disorder.     

Preference for immediate reinforcement in depression

In order to test predictions derived from Lewinsohn's behavioral analysis of depression, 92 undergraduates were given paper and pencil measures of depression, preference for immediate vs delayed reinforcement and value of social vs non-social reinforcements. Results indicated that more depressed Ss scored more in the direction of preferring immediate reinforcement and that this did not seem to be due to response bias. Depression was not related to social vs non-social reinforcer preference. Results were discussed in relation to the function of depressive behavior.     

Aversive stimulation to eliminate infant nocturnal rocking

A quasi-experimental time-series research design was employed to study planned intervention in the nocturnal rocking behavior of a 25-month-old normal female infant. The girl was subjected to aversive stimuli in the form of a bright light contingent upon rocking behavior. The rocking behavior was immediately reduced and completely eliminated in 26 consecutive nights of treatment.     

Alcoholism treatment by disulfiram and community reinforcement therapy

Traditional disulfiram treatment has often been ineffective because of a failure to maintain usage. The present study with 43 alcoholics compared: (1) a traditional disulfiram treatment, (2) a socially motivated Disulfiram Assurance program and (3) a Disulfiram Assurance program combined with reinforcement therapy. About five sessions were given for each program. At the 6-month follow-up, the traditional treatment clients were drinking on most days and no longer taking the medication. The Disulfiram Assurance treatment resulted in almost total sobriety for married or (cohabitating) clients but had little benefit for the single ones. The combined program produced near-total sobriety for the single and married clients. These results indicate a promising integration of chemical, psychological and social treatment of alcoholism.     

The effects of varying schedules of time-out on aggressive behavior of a retarded girl

Three schedules of time-out were compared for suppressing aggressive behavior in a 7-yr-old retarded girl. The schedules (FR5, FR2, CRF) were time-out after every 5th, 2nd or every aggressive act. The FR5 schedule had no effect on rate of aggressive behavior while the FR2 and CRF schedules both produced significant reductions, the CRF being more effective. This reduction was maintained at follow-up after 5 weeks. It appears that time-out may be effective proportionate to the percentage of target behaviors it follows, and that some success can be achieved with less than continuous application.     

Indirect modification of adolescent drug abuse using contingency contracting

Contingency contracting was used to modify the relationship between a poly-drug abusing adolescent and his family. Concomitant with improvement in the family relationship there was a marked decrease in drug use. Implications for the indirect modification of drug abuse and the importance of negotiation in contingency contracting are discussed.     

Teaching an autistic child pedestrian skills

An autistic child was taught pedestrian skills in a classroom by use of a model of the streets and the intersection she most often frequented. She manipulated a doll and verbalized what the doll was doing to get to the designated location. After mastering the pedestrian skills on the model, video recordings familiarized her with traffic at local intersections. She successfully generalized the pedestrian skills to the natural environment.     

Paradoxical intention in the treatment of obsessional flatulence ruminations

A case study of the paradoxical treatment of long standing obsessional ruminations about flatulence in a 33-year old female respiratory therapist is described. Self- reported estimates of the frequency and intensity of flatulence were unaffected by a misconception correction procedure that entailed the presentation of scientific data disconfirming the bases of her concerns. Paradoxical instructions to intensify flatus emissions were then employed. These instructions resulted in a rapid elimination of the obsessional ruminations; this improvement was enhanced at 1 yr follow-up.     

Physical fitness level and autonomic reactivity to psychosocial stress

Two studies explored the influence of aerobic fitness level on autonomic reactivity to psychosocial stress. Experiment 1 employed a correlational, repeated measures design. A total of 45 men who were physically trained, untrained, or training were tested at three-week intervals over nine weeks. The measure of autonomic reactivity was lability in electrodermal activity during two speeded mental tasks designed to induce psychosocial stress. In the initial test session, trained subjects showed faster autonomic recovery from this stress than did untrained or training subjects; in subsequent test sessions involving the repeated administration of the same tasks, the three groups were indistinguishable. Experiment 2 employed 60 subjects who were randomly assigned to 10-week aerobic exercise, meditation, or music appreciation programs. In each session, two psychosocial stressors selected from a battery of six tasks were counterbalanced across treatments and sessions. Over the course of the study, participants in the exercise program improved significantly in physical fitness and also showed faster recovery in the electrodermal response. This quicker autonomic recovery may allow the aerobically fit to cope more effectively with emotional stress.     

Thought-stopping and stimulus control to decrease persistent disturbing thoughts

This paper describes the successful treatment of two cases that presented problems of compulsive disturbing thoughts. Both cases included a thought-stopping component to terminate the disturbing thoughts, and a stimulus control component—through the use of photographs, to increase alternative desirable thoughts.