Behavior Modification current issue

Context-Based Assessment and Intervention for Problem Behavior in Children With Autism Spectrum Disorder

Cale, S. I., Carr, E. G., Blakeley-Smith, A., Owen-DeSchryver, J. S. — Fri, 20 Nov 2009 12:49:33 PST

The present study used a context-based model of assessment and intervention to explore whether interventions that modify context result in reduction of problem behavior in ecologically valid settings (i.e., typical routines implemented by typical education personnel in neighborhood schools). The Contextual Assessment Inventory (CAI) and a postassessment interview were administered to parents and teachers of eight children with Autism Spectrum Disorder to identify problem contexts. Then, environmental modification techniques were implemented in three priority contexts: namely, transitions, termination of preferred activities, and presence of a feared stimulus. Our results demonstrated an almost complete elimination of problem behavior in the priority contexts as well as successful completion of activities and routines related to those contexts. We discuss the value of conceptualizing problem behavior as a function of context with respect to facilitating both assessment and intervention, and the need for enhancing breadth of effects to determine the larger impact of a context-based approach on promoting meaningful behavior change in the community.

Relationship of Exposure to Clinically Irrelevant Emotion Cues and Obsessive-Compulsive Symptoms

Allen, L. B., Barlow, D. H. — Fri, 20 Nov 2009 12:49:33 PST

Research has highlighted the role of emotion regulation as a common factor underlying emotional disorders. The current study examined the relationship of emotion regulation skills to obsessive-compulsive disorder (OCD) symptoms. Seven participants with a principal diagnosis of OCD in a multiple-baseline across subjects design were taught the skill of prevention of emotional avoidance in the context of emotion provocation procedures to clinically irrelevant (nonspecific) cues prior to practicing this skill with clinically relevant (OCD-specific) cues. Results suggested successful acquisition of emotion regulation skills (as evidenced by decreased thought suppression and increased acceptance of thoughts and feelings) in clinically irrelevant contexts. Acquisition of this skill was associated with decreases in obsessive-compulsive symptoms, even though clinically relevant cues were not introduced during this phase. Implementation of skills in clinically relevant contexts was associated with greater reductions in OCD symptoms. Discussion focuses on implications for emotion regulatory processes in the maintenance and treatment of emotional disorders.

Biased Processing of Threat-Related Information Rather Than Knowledge Deficits Contributes to Overestimation of Threat in Obsessive-Compulsive Disorder

Moritz, S., Pohl, R. F. — Fri, 20 Nov 2009 12:49:33 PST

Overestimation of threat (OET) has been implicated in the pathogenesis of obsessive-compulsive disorder (OCD). The present study deconstructed this complex concept and looked for specific deviances in OCD relative to controls. A total of 46 participants with OCD and 51 nonclinical controls were asked: (a) to estimate the incidence rate for 20 events relating to washing, checking, positive, or negative incidents. Furthermore, they were required (b) to assess their personal vulnerability to experience each event type, and (c) to judge the degree of accompanying worry. Later, participants were confronted with the correct statistics and asked (d) to rate their degree of worry versus relief. OCD participants did not provide higher estimates for OCD-related events than healthy participants, thus rendering a knowledge deficit unlikely. The usual unrealistic optimism bias was found in both groups but was markedly attenuated in OCD participants. OCD-related events worried OCD participants more than controls. Confrontation with the correct statistics appeased OCD participants less than healthy participants. Even in the case of large initial overestimations for OCD-related events, correct information appeased OCD participants significantly less than healthy participants. Our results suggest that OCD is not associated with a knowledge deficit regarding OCD-related events but that patients feel personally more vulnerable than nonclinical controls.

Group-Based Preference Assessment for Children and Adolescents in a Residential Setting: Examining Developmental, Clinical, Gender, and Ethnic Differences

Resetar Volz, J. L., Cook, C. R. — Fri, 20 Nov 2009 12:49:33 PST

This study examines developmental, clinical, gender, and ethnic group differences in preference in residentially placed children and adolescents. In addition, this study considers whether residentially placed youth prefer stimuli currently being used as rewards as part of a campuswide token economy system and whether youth would identify preferred stimuli that are not currently offered. The article discusses a survey devised specifically for the purpose of this study. Stimuli currently offered as rewards are listed and rated on a 5-point Likert-type scale. Results indicate that the majority of stimuli available within the token economy system were rated as preferred. Also, significant developmental, clinical, gender, and ethnic group differences are found, indicating the benefit of considering group-level characteristics when designing and implementing a groupwide token economy system. The implications of the results and directions for future research are discussed.

Prediction of Exercise in Patients Across Various Stages of Bariatric Surgery: A Comparison of the Merits of the Theory of Reasoned Action Versus the Theory of Planned Behavior

Hunt, H. R., Gross, A. M. — Fri, 20 Nov 2009 12:49:33 PST

Obesity is a world-wide health concern approaching epidemic proportions. Successful long-term treatment involves a combination of bariatric surgery, diet, and exercise. Social cognitive models, such as the Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TPB), are among the most commonly tested theories utilized in the prediction of exercise. As exercise is not a completely volitional behavior, it is hypothesized that the TPB is a superior theoretical model for the prediction of exercise intentions and behavior. This study tested validity of the TPB in a sample of bariatric patients and further validated its improvement over the TRA in predicting exercise adherence at different operative stages. Results generally confirmed research hypotheses. Superiority of the TPB model was validated in this sample of bariatric patients, and Perceived Behavioral Control emerged as the single-best predictor of both exercise intentions and self-reported behavior. Finally, results suggested that both subjective norms and attitudes toward exercise played a larger role in the prediction of intention and behavior than previously reported.

Behavioral Activation Is an Evidence-Based Treatment for Depression

Sturmey, P. — Fri, 20 Nov 2009 12:49:33 PST

Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of an earlier randomized control trial. Behavioral activation was consistently superior to wait list and treatment as usual control groups. Effect sizes were not different from cognitive behavior therapy or cognitive therapy, both post-treatment and at follow-up. Indeed, behavioral activation may be more effective than cognitive therapy and cognitive behavior therapy in terms of lower dropout. Behavioral activation, like cognitive behavior therapy, may be superior to paroxitine because it results in less relapse and recurrence, may be substantially cheaper, and does not have risks of pharmacotherapy. There is some evidence that behavioral activation may also be useful with some people for whom cognitive and cognitive-behavior therapy is less effective, such as those with severe, lifelong depression, people with substance abuse and people with dementia and severe depression. There is now sufficient evidence to conclude that behavioral activation is an evidence-based therapy.

The Validity of Virtual Environments for Eliciting Emotional Responses in Patients With Eating Disorders and in Controls

Ferrer-Garcia, M., Gutierrez-Maldonado, J., Caqueo-Urizar, A., Moreno, E. — Fri, 20 Nov 2009 12:49:33 PST

This article explores the efficacy of virtual environments representing situations that are emotionally significant to patients with eating disorders (ED) to modify depression and anxiety levels both in these patients and in controls. Eighty-five ED patients and 108 students were randomly exposed to five experimental virtual environments (a kitchen with low-calorie food, a kitchen with high-calorie food, a restaurant with high-calorie food, a restaurant with low-calorie food, and a swimming-pool) and to one neutral environment. In the interval between the presentation of each situation, anxiety and depressed mood were assessed. Results of several repeated measures analyses demonstrated that patients show higher levels of anxiety and a more depressed mood after eating, especially high-calorie food, and after visiting the swimming pool than in the neutral room. In contrast, controls only show higher levels of anxiety in the swimming pool. In the rest of the situations they presented a similar mood state as in the neutral room. We concluded that virtual reality is a useful vehicle for eliciting similar emotional reactions to those one would expect in real life situations. Thus, this technology seems well suited for use in experimental studies as well as in evaluative and therapeutic contexts.

Effectiveness of Teacher-Child Interaction Training (TCIT) in a Preschool Setting

Fri, 20 Nov 2009 12:49:33 PST

This research addressed the need for trained child care staff to support optimal early social-emotional development in urban, low-income, ethnic minority children. We evaluated effectiveness of Teacher-Child Interaction Training (TCIT), an approach adapted from Eyberg’s Parent-Child Interaction Therapy (PCIT). TCIT focuses on increasing preschool teachers’ positive attention skills and consistent discipline in order to enhance children’s psychosocial functioning and prevent mental health problems. A total of 12 teachers participated in small-group workshop sessions with in vivo coaching on their use of skills in the classroom. A multiple-baseline design across four classrooms (3 teachers each) evaluated effects of training on teacher behaviors during weekly classroom observations. Findings indicated systematic increases in trained skills during intervention, and consumer evaluations showed that the training was rated positively. Our results suggest that TCIT is a promising approach for enhancing positive teacher-child interactions in a preschool setting and should receive further investigation.