A seven year follow-up of treating rumination with dietary satiation

”Fred“, a man with profound mental retardation who was 24 years old at the beginning of this study, was referred for treatment of rumination. A number of minimally restrictive interventions, including administration of Zantac, extra fluids, and delivery of peanut butter after meals, had been used without success. In April of 1989 Fred began a satiation diet with ad libitum access to starchy foods or to fruits and vegetables, in addition to his regular meals. His baseline weight was 82 pounds and he ruminated during 58% of 10 s intervals measured during 20 min post-meal observations. During the first month of the satiation diet, Fred's ruminating declined to 6% of measured intervals, he consumed a mean of 163 fluid ounces of extra food per day, and his weight increased to 90 pounds. After 4 months' treatment, Fred's ruminating had declined to zero, his food consumption had stabilized at approximately 65 extra ounces of food per day, and his weight had stabilized at about 120 pounds. Starting in August 1990, in an effort to minimize weight gain, extra food was limited to 50% of Fred's ad libitum food consumption (averaged over the previous 6 weeks). Fred's weight gradually declined to about 100 pounds with zero rumination over the next two years. In August 1992 Fred's ruminating accelerated to 17% of intervals and he was again offered ad libitum food access. Over the next 7 months, rumination declined to zero and his weight increased slightly to about 105 pounds. This study shows that rumination that had not responded to less restrictive procedures was suppressed for 7 years via dietary satiation. Although dietary satiation is not without some risk, Fred has suffered no adverse effects from the procedure, other than gaining approximately one-third of his baseline weight. © 1997 John Wiley & Sons, Ltd.     

On the effects of noncontingent food delivery during naturally occurring periods of deprivation and satiation

Four adults diagnosed with moderate to profound mental retardation performed a manual response that was reinforced with food identified from a stimulus preference assessment. During baseline, the response was reinforced on a variable ratio (VR) schedule. Participants were then exposed to noncontingent reinforcement (NCR) plus extinction, and no‐food (i.e., extinction) conditions. A combination multielement and reversal design was used to evaluate intervention effects. For each participant, sessions were conducted both before and after the midday meal during baseline and NCR‐plus‐extinction conditions, thus capitalizing on naturally occurring states of food deprivation and satiation. Results showed that response rates were slightly higher during deprivation sessions than during satiation sessions during NCR‐plus‐extinction and VR schedules for three of the four participants. For three participants, initial NCR schedules did not reduce responding; however, subsequent NCR schedules, which were twice as dense, were effective in reducing response rates. The results are discussed in terms of the development of NCR as a reductive technology and the manipulation of establishing operations applied to the habilitation of individuals with developmental disabilities. The use of a basic experimental preparation as a method of examining decelerative interventions is also addressed. Copyright © 2000 John Wiley & Sons, Ltd.     

A comparison of noncontingent reinforcement,other competing stimulation,and liquid rescheduling for the treatment of rumination

Modified versions of three popular nonaversive treatments for rumination in a person with profound developmental delay were evaluated using an alternating treatments design (ATD) as a component of an ABAB design. Results showed that the most effective intervention involved noncontingent feeding every 20 s for the 30 min immediately following a meal. Further analysis demonstrated that no significant increase in rumination occurred during the 60 min after the treatment procedure had expired, thus indicating that rumination was not merely postponed. Results are discussed in terms of their relation to currently popular (satiation) interventions for the treatment of rumination in individuals with developmental disability. Future research needs are proposed from an analysis of known behavioral and physiological variables and their possible interactions. ©1997 by John Wiley & Sons, Ltd.     

EFFECTS OF AN ORAL HYGIENE PUNISHMENT PROCEDURE ON CHRONIC RUMINATION AND COLLATERAL BEHAVIORS IN MONOZYGOUS TWINS

This study investigated the suppressive effects of an oral hygiene punishment procedure on the ruminative behavior of profoundly retarded monozygous twins. Rumination, fingers in mouth/tongue out, appropriate behavior, and stereotyped behavior were measured before and during treatment with oral hygiene. Treatment was introduced for each meal in succession across the twins in a multiple-baseline design. Results showed that the rate of rumination of both twins was dramatically reduced to very low levels and stereotyped behavior increased spontaneously with the introduction of oral hygiene. Maintenance data showed that response reduction was maintained over a six-month period and, when compared to baseline levels, increased rates of socially appropriate behavior were evident in both children.     

Empirically derived consequences to treat rumination

We evaluated a contingent oral hygiene procedure on rumination emitted by a 9‐year‐old boy with autism. Results of a functional analysis screening suggested rumination was maintained by automatic reinforcement. We conducted a stimulus avoidance assessment to identify a hierarchy of potential consequences to be used in treatment. During treatment, contingent toothbrushing resulted in a 97% decrease in rumination. Finally, we transitioned to a less intrusive intervention (i.e., contingent mouthwash spray) and rumination remained at near‐zero levels. Treatment effects generalized to different settings and caregivers and maintained over a 4‐year period.     

REDUCTION OF RUMINATION USING A SUPPLEMENTAL STARCH FEEDING PROCEDURE

A supplemental starch feeding (SSF) procedure was used to decrease rumination in a 27‐year‐old man. A multiple baseline across mealtimes design determined treatment efficacy, followed by 26 months of maintenance and fading implemented by direct‐care staff. Following intermittent meals, four slices of bread were offered in a paced manner, after which the frequency of rumination was measured. Subsequent to the SSF sessions, the participant's rumination reduced 47%, from 0.19 per minute (8.5 per session) after baseline sessions to 0.09 per minute (4.1 per session) after treatment sessions. Ongoing measures in the natural setting continued to show reductions through maintenance and fading of the supplemental feeding. No weight gain was noted during the time the procedure was in place. Copyright © 2011 John Wiley & Sons, Ltd.     

THE USE OF A VERBAL REPRIMAND TO DECREASE RUMINATION IN A CHILD WITH AUTISM

After a pre‐treatment screening analysis suggested that rumination exhibited by a boy with autism occurred in the absence of social consequences, we evaluated the effect of a verbal reprimand contingent on the target behavior via a reversal design. The reprimand reduced rumination to near‐zero levels; we then thinned the reprimand schedule and rumination remained infrequent. Follow‐up data collected 6, 12, and 18 months after initial treatment suggested that intervention effects were maintained. Copyright © 2014 John Wiley & Sons, Ltd.     

Reinforcing efficacy of food on performance during pre- and postmeal sessions

Assessments were conducted to identify preferred foods for 9 adults with severe to profound mental retardation. Subsequently, the reinforcing effects of each participant's most highly preferred food were evaluated during sessions conducted before and after lunch. Results showed that 4 participants' response rates were higher during premeal sessions than during postmeal sessions. By contrast, pre- and postmeal response rates were indistinguishable for the other 5 participants. These results indicate that the reinforcing efficacy of food may (but does not necessarily) diminish following meals and suggest that the influence of meal schedules should be examined on an individual basis when food is used as reinforcement during training sessions.     

Differential reinforcement of high rate behavior to increase the pace of self‐feeding

Although numerous studies have examined treatments for increasing food consumption among children with pediatric feeding disorders, very few have examined treatment of other mealtime‐related difficulties. One such problem is a slow pace of self‐feeding, which can lead to caregivers failure to adhere to treatments or be disruptive to others. We examined the effects of a differential reinforcement of high rate (DRH) intervention to increase a 9‐year‐old boy's pace of self‐feeding. During treatment, the child received reinforcement contingent on consuming his meal within 30 min. Results showed an increase in the pace of self‐feeding and a concomitant decrease in meal duration as compared to baseline. Copyright © 2008 John Wiley & Sons, Ltd.     

Functional Analysis and Treatment of Mealtime Problem Behavior for a Person with Developmental Disabilities

We conducted a functional analysis of problem behaviors (spitting and whining) during meals and tested an intervention based on that analysis. The participant was a 13-year-old young woman with severe mental retardation and cerebral palsy. She ate all food presented to her, and the hypotheses were tested that the problem behaviors were maintained either by contingent access to trainer attention or the pace of eating. An attention analysis examined the relationship between problem behavior and trainer attention during the meal. The effect of attention following problem behavior versus ignoring was inconclusive. An analysis of the effects of teacher paced eating, student paced eating (reinforce spoon grasping) and food presented for problem behavior was conducted next. Problem behavior rates were highest when access to food was made contingent on the performance of problem behavior and lowest when spoon grasping resulted in a bite of food. Following analysis, an intervention was designed to reduce the frequency of targeted problem behaviors during mealtime. Reinforcing spoon grasping and a 10s removal of food following problem behavior dramatically reduced spitting and whining during meals. The study provides a demonstration of an extended functional analysis and treatment of a complex behavior pattern.     

Experience with dynamic reinforcement rates decreases resistance to extinction

The ability of organisms to detect reinforcer‐rate changes in choice preparations is positively related to two factors: the magnitude of the change in rate and the frequency with which rates change. Gallistel (2012) suggested similar rate‐detection processes are responsible for decreases in responding during operant extinction. Although effects of magnitude of change in reinforcer rate on resistance to extinction are well known (e.g., the partial‐reinforcement‐extinction effect), effects of frequency of changes in rate prior to extinction are unknown. Thus, the present experiments examined whether frequency of changes in baseline reinforcer rates impacts resistance to extinction. Pigeons pecked keys for variable‐interval food under conditions where reinforcer rates were stable and where they changed within and between sessions. Overall reinforcer rates between conditions were controlled. In Experiment 1, resistance to extinction was lower following exposure to dynamic reinforcement schedules than to static schedules. Experiment 2 showed that resistance to presession feeding, a disruptor that should not involve change‐detection processes, was unaffected by baseline‐schedule dynamics. These findings are consistent with the suggestion that change detection contributes to extinction. We discuss implications of change‐detection processes for extinction of simple and discriminated operant behavior and relate these processes to the behavioral‐momentum based approach to understanding extinction.     

Schedule-induced defecation: No-food and massed-food baselines

Defecation rate was monitored during daily 30-min periods as 16 rats were exposed to different sequences of the following three experimental conditions: (a) a fixed-time 60-s food delivery schedule, (b) a massed-food presentation baseline, and/or (c) a no-food baseline. All food delivery was response independent. Rate of defecation increased during fixed-time 60-s food delivery when compared to baseline rates of defecation established during no-food and massed-food baselines. This effect was present for 12 of 16 rats during four alternative sequences of experimental conditions. Within-subject reversals established reliability of this effect. Schedule induction of defecation is clearly demonstrated under these conditions.     

Competitive Memory Training for treating depression and rumination in depressed older adults: a randomized controlled trial

Although rumination is an important mediator of depressive symptoms, there is insufficient proof that an intervention that specifically targets rumination ameliorates the clinical condition of, depressed patients. This study investigates whether a time-limited cognitive behavioral intervention (Competitive Memory Training, or COMET for depressive rumination) is an effective treatment for depression and rumination. This intervention was tested in older adult depressed outpatients. A total of 93 patients (aged ≥65 years with major depression and suffering from rumination) were treated in small groups according to the COMET protocol in addition to their regular treatment. Patients were randomized to two treatment conditions: 7 weeks of COMET + treatment-as-usual (TAU) versus TAU only. COMET + TAU showed a significant improvement in depression and rumination compared with TAU alone. This study shows that the transdiagnostic COMET protocol for depressive rumination might also be successful in treating depression and rumination in older adults.     

Food priming: A therapeutic tool to increase the percentage of meals bought by chronic mental patient

In a motivating ward environment for schizophrenics, three methods of maximizing food as an effective reinforcer were tested. On the basis of pre-treatment measures, patients were classified as (1) “non-chronic meal missers” who served as control patients (Group A), (2) “chronic meal missers” because they had no tokens (Group B), or (3) “chronic meal missers” because they chose not to eat but had tokens (Group C). One of the following three experimental treatments was then administered when a patient missed a meal : (1) visual food priming (observing others eat), (2) oral food priming (sampling one teaspoon of each type of food for that meal), and (3) free meal (being offered a free meal when it was missed). Oral and visual food priming were found to be equally effective in increasing the percentage of meals bought by patients. A post-treatment follow-up for Group B found that this increase was even greater during the follow-up phase. The percentage of meals bought by patients in the free meal condition of Group B decreased during the treatment phase but was significantly above pre-treatment measures during the follow-up phase, suggesting that complete reinforcer sampling may also be an effective technique for increasing the percentage of meals bought.     

Variable-interval reinforcement schedule value influences responding following REM sleep deprivation

The effects of rapid-eye movement sleep deprivation (REMSD) in rats were studied in relation to variable-interval (VI) reinforcement schedule value. Initially, lever pressing was maintained on a VI 30-s schedule of food pellet delivery. After a baseline was established, rats were repeatedly exposed to 96 hr of REMSD and control conditions of an equivalent duration. Responding decreased following REMSD but not after exposure to control conditions. Lever pressing was then maintained on a VI 15-s schedule of food pellet delivery and exposure to the REMSD and control conditions was repeated. Under this condition following repeated REMSD exposures, rates of lever pressing became similar to baseline responding. A VI 30-s schedule of food pellet delivery was then reinstated and REMSD and control conditions were repeated. Lever pressing following exposure to the REMSD condition decreased for 3 of 4 rats. Results suggest that VI schedule value influences the effects of REMSD on responding.     

Slower eating rate reduces the food intake of men, but not women: implications for behavioral weight control

This study tested a central tenet of behavioral weight control: does slower eating rate reduce food intake and positively affect appetite ratings. This study used direct behavioral observation of participants' (n=48; 25BMI35) eating behavior using Universal Eating Monitors. Food intake and ratings of "desire to eat" (collected each minute during meals) were represented as a function of time. Based on an acclimation meal, participants' eating rate was modified by instructing them to eat a bite of food when prompted by a computer, which generated three types of meals: (1) baseline (eating rate was the same as the acclimation meal), (2) reduced-rate (eating rate was reduced by 50%), and (3) combined-rate (eating rate at the beginning of the meal was identical to that of the acclimation meal, subsequently eating rate was reduced by 50%). All meals were ad libitum. Slower eating rate during the reduced-rate and combined-rate meals resulted in less food intake compared to the baseline meal for men, but not women. Ratings of desire to eat, normalized for the amount of food consumed, were lower during the combined-rate meal for men and women. Thus, this basic premise of behavioral weight control was supported for men, but not for women.     

The combined effects of noncontingent reinforcement and punishment on the reduction of rumination

The current study extends the literature on the assessment and treatment of rumination through the evaluation of a combined reinforcement‐ and punishment‐based intervention. The study included a single participant with a history of rumination maintained by automatic reinforcement, as identified via a functional analysis. Both noncontingent reinforcement (NCR) with preferred edible items and punishment, in the form of a facial screen, were implemented separately to evaluate their independent effects on the occurrence of rumination. The final treatment package included both NCR and punishment procedures. Implementation of the combined treatment resulted in a 96.5% reduction in rumination relative to baseline. Procedural modifications and integrity errors also were evaluated.     

Perfectionism as a Predictor of Post-event Rumination in a Socially Anxious Sample

Socially anxious individuals tend to have elevated levels of perfectionism and engage in excessive rumination following social situations. The present research aimed to examine perfectionism, in both state and trait forms, as a predictor of post-event rumination. Socially anxious students (N = 104) completed measures of trait perfectionism prior to, and state perfectionism following, an anxiety inducing speech task. Post-event rumination was assessed 2 days later. State and trait perfectionism were significant predictors of post-event rumination (2 days later), while controlling for baseline social anxiety, depression and state anxiety. These results support the need to target perfectionism in treatments for social anxiety disorder.     

Behavioral momentum theory fails to account for the effects of reinforcement rate on resurgence

The behavioral‐momentum model of resurgence predicts reinforcer rates within a resurgence preparation should have three effects on target behavior. First, higher reinforcer rates in baseline (Phase 1) produce more persistent target behavior during extinction plus alternative reinforcement. Second, higher rate alternative reinforcement during Phase 2 generates greater disruption of target responding during extinction. Finally, higher rates of either reinforcement source should produce greater responding when alternative reinforcement is suspended in Phase 3. Recent empirical reports have produced mixed results in terms of these predictions. Thus, the present experiment further examined reinforcer‐rate effects on persistence and resurgence. Rats pressed target levers for high‐rate or low‐rate variable‐interval food during Phase 1. In Phase 2, target‐lever pressing was extinguished, an alternative nose‐poke became available, and nose‐poking produced either high‐rate variable‐interval, low‐rate variable‐interval, or no (an extinction control) alternative reinforcement. Alternative reinforcement was suspended in Phase 3. For groups that received no alternative reinforcement, target‐lever pressing was less persistent following high‐rate than low‐rate Phase‐1 reinforcement. Target behavior was more persistent with low‐rate alternative reinforcement than with high‐rate alternative reinforcement or extinction alone. Finally, no differences in Phase‐3 responding were observed for groups that received either high‐rate or low‐rate alternative reinforcement, and resurgence occurred only following high‐rate alternative reinforcement. These findings are inconsistent with the momentum‐based model of resurgence. We conclude this model mischaracterizes the effects of reinforcer rates on persistence and resurgence of operant behavior.     

A multi‐component approach to the treatment of chronic rumination

A multi‐component intervention was used to treat chronic rumination exhibited by an adult female diagnosed with a developmental disability. The intervention consisted of: (a) interruption of precursor behavior, (b) the alternation of 10‐min periods of continued instruction that involved walking and working with (c) 10‐min periods in which instructions were not delivered but a variable time 5‐s schedule of noncontingent attention was programmed, and (d) a 1‐min differential reinforcement of other behavior (DRO) schedule. During the intervention, rumination decreased by 82% relative to baseline. Next, components of the multi‐component intervention were systematically removed to evaluate their individual contribution. Results suggested that each individual component contributed to the overall treatment effects. Copyright © 2010 John Wiley & Sons, Ltd.