Night terrors

Night terrors and nightmare had for years been equated terms. Early writers tended to ignore the differences. Even today with a clearer definition and understanding of these sleep disturbances, practitioners have been at a loss on how to ameliorate the very upsetting set of occurrences (to the patient as well as to the family). This paper briefly reviews some of the literature on Night Terrors and reports successes in the amelioration of this phenomenon.     

助推手卫生的行为干预策略

保持手卫生是感染防控的重要策略,但是如何提高其依从性成为预防传染性疾病和减少医疗机构获得性感染的一大挑战。以行为科学为基础的手卫生助推干预以更“隐性”的方式将洗手转变为一种可自动触发的行为习惯,弥补了以知识分享和健康宣教为主的传统手卫生干预策略的诸多局限性。基于影响机制的不同,手卫生助推干预策略可分为提供决策信息、优化决策选项、影响决策结构、提醒决策方向4个大类的框架体系。多模式助推策略的有效性也已在实践中得到印证,但目前还非常缺乏在中国社会文化情境下开展的助推洗手行为的干预研究,今后可尝试基于行为科学理论有针对性地在医院、学校和社区等公共场所开展此类干预研究和实践,为感染防控、疾病预防和改善公共健康做出相应的贡献。     

助推戒烟的行为干预策略

烟草危害是人类所面临的重大公共健康挑战之一。传统的控烟策略主要依赖健康宣教、烟草税和控烟条例等手段,但是较少考虑到吸烟行为的“非理性因素”及其心理机制,因此仍不能有效帮助吸烟者成功戒烟。行为科学的发展为助推吸烟者成功戒烟提供了新视角。以实施主体和干预的影响机制为划分标准,可将助推戒烟的行为干预策略分为由政府和公共健康服务部门执行的情境型干预策略和认知型干预策略以及吸烟者可自主执行的情境型和认知型干预策略,一方面便于吸烟者和相关部门选取可执行的戒烟行为干预策略,另一方面为进一步开发和验证助推戒烟的行为干预策略提供参考。虽然基于行为科学的助推干预策略已经取得了一定的进展,未来研究仍有必要进一步在真实世界中验证和评估戒烟助推干预策略的效果。未来也有必要进一步将行为改变技术融入到数字化的戒烟服务或应用小程序中去以提升其效果。未来也需要考察如何应用戒烟助推干预策略防止电子烟产品的负面影响并减少这类策略的误用和滥用。     

Behavioral,subjective, and electroencephalographic indices of sleep onset latency and sleep duration

Electrographic (EEG, EOG, EMG) indices have been used for some decades in the definition of the stages of sleep and more recently in the diagnosis of sleep-related disorders, e.g., insomnia, despite the lack of detailed information concerning the precise relationship between such electrographic indices and behavioral and subjective criteria of sleep. Evaluation of the relationship between EEG, behavioral, and self-report measures of sleep onset latency and sleep duration was conducted using 17 young normal sleepers. The behavioral measure was provided by an apparatus which records subjects' button-press responses to an auditory stimulus presented at various interstimulus intervals (2, 5, and random 1, 2, 5, 7, and 10 min). The behavioral and stage 2 EEG estimates of sleep onset latency (SOL) and sleep duration (SD) were almost identical. The stage 1 EEG provided the shortest estimate of SOL; the self-report measure, the longest. The SD measures were in reverse order. There were no significant differences among the three interstimulus interval conditions (2, 5, and random min). Average response rates to the 50-dB chime were 100% during wakefulness, 81% during EEG stage 1, and 8% during EEG stage 2. Almost all stage 2 responding occurred during the first 5 min of each stage 2 period. The validity of electrographic indices as sleep criteria and the implications of the findings for the formulation of an adequate definition of sleep and its clinical measurement are discussed.     

Early childhood intervention. A promising preventative for juvenile delinquency.

Programs to reduce or prevent juvenile delinquency have been generally unsuccessful. Apparently the risk factors that make a child prone to delinquency are based in too many systems--including the individual, the family, and community networks--to make isolated treatment methods effective. Surprisingly, longitudinal studies of some early childhood intervention programs suggest they may help to reduce future delinquency. These programs take an ecological approach to enhancing child development by attempting to promote overall social competence in the many systems impacting on children. Not engaging in criminal acts is one indicator of competence that is related to others, such as being successful in school and in personal relationships. Evaluators must gather more data to confirm this unanticipated benefit of comprehensive interventions.     

Habituation of orienting reaction in night terrors

A polygraphic study on resistance to habituation of the somatic (EMG), autonomic (finger vasoconstriction, galvanic skin reaction, respiration, pulse) and EEG (acoustic-evoked potential, EEG-blocking reaction) components of the orienting reaction elicited by a repetitive auditory stimulus was performed in 36 patients with night terrors and in 72 matched subjects in two control groups. The study evidenced a significantly higher resistance to habituation of the orienting reaction in patients with night terrors than in normal subjects (control group I) but significantly lower than in patients with symptomatic epilepsy (control group II). The severity of these habituation disturbances in patients with night terrors depended on the patients’ age, the history of nocturnal events and their clinical form, as well as on the etiology of episodes. The habituation changes found in patients with night terrors may be ascribed to the nervous disorders of functional and/or organic nature which generated also the night terrors episodes.     

行为干预情绪记忆再巩固：从实验室到临床转化

重新激活已经储存的记忆会重返暂时不稳定的状态, 需要经历重新稳定, 称为记忆再巩固。在这期间可以通过多种行为手段破坏、强化或更新原始记忆痕迹, 这为开发一种革命性的情绪记忆障碍治疗方法开辟了道路。然而, 即使在简单的实验模型中引发记忆再巩固的条件也是复杂的, 这给临床转化带来了困难与挑战。未来研究可以设置更具生态效应的基础模型, 寻求引发以及干预再巩固的最佳方式, 从神经生理、细胞分子层面进一步深化其内在机理研究。     

Behavioral intervention to reduce physical restraint of adolescents with developmental disabilities

Physical restraint procedures sometimes are approved for implementation in human service settings for children and adults who have developmental disabilities and seriously challenging behaviors. Although use of restraint may be clinically justified to manage behavior disorders and prevent injury to self and others, procedures should be evaluated to decrease, and possibly eliminate, such methods. This study addressed the effects of restraint‐reduction procedures with two adolescents who had developmental disabilities and displayed severe aggression. Clinically significant reductions in the frequency of physical restraint were achieved through a treatment package that included the behavior‐specific criterion for the application of restraint and antecedent control approaches. The implementation of strategic interventions to decrease physical restraint utilization is discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

Psychophysiological aspects of nightmares, night terrors, and sleepwalking

Monitoring sleep through electroencephalography and electroculography has identified the different sleep stages in which nightmares, night terrors, and sleepwalking occur. Questionnaire surveys have supplemented the findings of case studies of these sleep disorders. Neurotransmitters operative during these sleep disorders have enlarged the knowledge of the psychophysiological dimensions especially of nightmares.     

The Accuracy of Behavioral Intention Versus Behavioral Expectation for Predicting Behavioral Goals

Researchers have largely overlooked the distinction between behavioral intention and behavioral expectation as predictors of one's own behavior. Moreover, the distinction between purely volitional behavior and behavioral goals, the latter of which may be impeded by such nonvolitional factors as lack of ability, lack of opportunity, habit, and environmental impediments, has also been blurred in the literature. Behavioral expectation is theorized to be based on a cognitive appraisal of one's behavioral intention and all other behavioral determinants of which one is aware. The present study argues and gives evidence that, although behavioral expectation and behavioral intention may have similar predictive accuracy for volitional behaviors, behavioral expectation is adequate, but behavioral intention may be inadequate for prediction of the accomplishment of behavioral goals.     

Triangulating causality between childhood obesity and neurobehavior: Behavioral genetic and longitudinal evidence

Childhood obesity is a serious health concern that is not yet fully understood. Previous research has linked obesity with neurobehavioral factors such as behavior, cognition, and brain morphology. The causal directions of these relationships remain mostly untested. We filled this gap by using the Adolescent Brain Cognitive Development study cohort comprising 11,875 children aged 9–10. First, correlations between the age- and sex-specific 95th BMI percentile (%BMIp95) and neurobehavioral measures were cross-sectionally analyzed. Effects were then aggregated by neurobehavioral domain for causal analyses. Behavioral genetic Direction of Causation modeling was used to test the direction of each relationship. Findings were validated by longitudinal cross-lagged panel modeling. %BMIp95 correlated with impulsivity, motivation, psychopathology, eating behavior, and cognitive tests (executive functioning, language, memory, perception, working memory). Greater %BMIp95 was also associated with reduced cortical thickness in frontal and temporal brain areas but with increased thickness in parietal and occipital areas. Similar although weaker patterns emerged for cortical surface area and volume. Behavioral genetic modeling suggested causal effects of %BMIp95 on eating behavior (β = 0.26), cognition (β = 0.05), cortical thickness (β = 0.15), and cortical surface area (β = 0.07). Personality/psychopathology (β = 0.09) and eating behavior (β = 0.16) appeared to influence %BMIp95. Longitudinal evidence broadly supported these findings. Results regarding cortical volume were inconsistent. Results supported causal effects of obesity on brain functioning and morphology. The present study highlights the importance of physical health for brain development and may inform interventions aimed at preventing or reducing pediatric obesity.

Research Highlights

• A continuous measure related to obesity, %BMIp95, has correlations with various measures of brain functioning and structure
• Behavioral genetic and longitudinal modeling suggest causal links from personality, psychopathology, and eating behavior to %BMIp95
• Results also indicate directional links from %BMIp95 to eating behavior, cognition, cortical thickness, and cortical surface area
• Obesity may play a role for healthy brain development during childhood

     

Behavioral interventions for childhood nocturnal enuresis: the differential effect of bladder capacity on treatment progress and outcome

Study participants were fifty 5- to 13-year-old children (33 boys and 17 girls) with nocturnal enuresis of at least 3 months duration. All wet their beds at least twice per week, were of normal intelligence, and were without demonstrable organic cause for their enuresis. Each youngster's pretreatment maximum functional bladder capacity (MFBC) was used to classify the child as having small or large MFBC based on available norms. Youngsters were then randomly assigned to treatment with the urine alarm (UA) alone or with the urine alarm supplemented with retention control training (UA plus RCT). Of the 40 youngsters who completed treatment, 37 (92.5%) achieved the treatment goal of 14 consecutive dry nights. Two additional children became dry during follow-up, leaving only one child who failed to stop wetting. Sixteen children (41%) subsequently relapsed, but all who reentered treatment became dry. Because treatment outcome was uniformly excellent across all groups, treatment progress was evaluated by analyzing wetting frequency and arising at night to use the bathroom during treatment, as well as prechange and postchange in MFBC For both wetting frequency and arising at night, there was a significant interaction between bladder capacity and treatment. Small MFBC children treated with the UA plus RCT and large MFBC youngsters treated with the UA alone had the fewest wetting episodes and got up at night to use the bathroom less often; these youngsters took less time to be successfully treated. Prechanges and postchanges in MFBC indicated that RCT did not lead to consistent increases in bladder capacity in the sample studies. The 10 children who terminated treatment prematurely had lower self-esteem and more parent-reported conduct problems than the 40 children who completed treatment.     

Behavioral intervention to treat selective mutism across multiple social situations and community settings

We evaluated a behavioral intervention for a 9-year-old girl with selective mutism. The intervention consisted of role play and video self-modeling. The frequency of spoken initiations, responses to questions, and communication breakdowns was measured during three social situations (i.e., ordering in a restaurant, meeting new adults, and playing with new children) and in three community settings. Results demonstrated increases in spoken initiations and responses and decreases in communication breakdowns across all situations and settings.     

An evidence-based group coping intervention for women living with HIV and history of childhood sexual abuse

Women living with HIV/AIDS and a history of childhood sexual abuse often exhibit sexual trauma symptoms and elevated rates of HIV-risk behaviors. In this paper, we describe a coping skills group intervention that reduced traumatic stress and sexual-risk behavior in a recent randomized clinical trial. We focused on clinical issues that emerged among female participants receiving the intervention. Clinical observations showed that recognizing connections between trauma, psychological distress, and high risk behaviors was a new and powerful experience for many participants. Participants successfully applied psychoeducational material, expressing an increased sense of power and control over their relationships and behaviors as they developed more adaptive cognitive and behavioral skills. Women expressed high levels of satisfaction with the intervention. Recommendations for clinical practice are provided.