BEHAVIORAL MANAGEMENT OF EXERCISE TRAINING IN VASCULAR HEADACHE PATIENTS: AN INVESTIGATION OF EXERCISE ADHERENCE AND HEADACHE ACTIVITY

A behavioral package was used to shape and maintain the adherence of 5 subjects with vascular headache to a program of aerobic exercise training. Repeated measures of exercise behavior were examined through the use of a bidirectional changing criterion design. Repeated measures of headache activity were also collected. Results demonstrated a functional relationship between the behavioral package and exercise adherence, because all 5 subjects showed exercise behavior that matched bidirectional changing exercise criteria. The results also indicated clinically significant collateral reductions in vascular headache activity in 4 subjects. Subjects whose aerobic fitness levels were not masked by vasoactive medication also showed measurable increases in aerobic fitness. The results are discussed in terms of the methodology used to demonstrate a functional relationship between the adherence package and exercise behavior and the possible mechanism(s) by which aerobic exercise activity might affect vascular headache activity.     

EVALUATION OF BIOFEEDBACK IN THE TREATMENT OF BORDERLINE ESSENTIAL HYPERTENSION1

Direct biofeedback of blood pressure was compared with frontal EMG biofeedback and with self-instructed relaxation for the treatment of essential hypertension in a controlled group outcome study. Patients were followed up for four months after the end of treatment. Generalization of treatment effects was assessed through pre- and posttreatment measurements of blood pressure under clinical conditions in a physician's office. There were no significant reductions in diastolic blood pressure. The systolic blood pressure (SBP) of the patients receiving blood pressure biofeedback decreased 8.1 mm mercury (p = 0.07) and the SBP of the patients in the relaxation condition decreased 9.5 mm mercury (p = 0.05). In the generalization measures, there were significant reductions in SBP for the relaxation group. The results are discussed in terms of the general lack of replicability within the area of biofeedback treatment of hypertension.     

BIOFEEDBACK,AUTOGENIC TRAINING,AND PROGRESSIVE RELAXATION IN THE TREATMENT OF RAYNAUD'S DISEASE: A COMPARATIVE STUDY

Twenty-one female patients suffering from diagnosed idiopathic Raynaud's Disease were trained to raise digital skin temperature using either autogenic training, progressive muscle relaxation, or a combination of autogenic training and skin temperature feedback. Patients were instructed in the treatment procedures in three one-hour group sessions spaced one week apart. All patients were instructed to practice what they had learned twice a day at home. Patients kept records of the frequency of vasospastic attacks occurring over a four-week baseline period, and during the first four weeks and the ninth week of training. In addition, patients underwent four laboratory cold stress tests during which they were instructed to maintain digital temperature as the ambient temperature was slowly dropped from 26° to 17°C. Cold stress tests were given during week 1 of baseline and during weeks 1, 3, and 5 of training. Results indicated that all patients improved during the first four weeks of training. No significant differences between the three behavioral treatment procedures were obtained. In addition, the ability of patients to maintain digital temperature during the cold stress challenge showed significant improvement from the first to the last tests. Symptomatic improvement was maintained by all patients nine weeks after the start of the training. The implications of these findings for the behavioral treatment of Raynaud's Disease are discussed.     

BEHAVIORAL MANAGEMENT OF EXERCISE: CONTRACTING FOR AEROBIC POINTS

Behavioral contracting was used to encourage physical exercise among college students in a multiple-baseline design. Subjects deposited items of personal value with the experimenters, which they could earn back on fulfillment of two types of contract contingencies. Subjects selected weekly aerobic point criteria, which they could fulfill by exercising in the presence of other subjects. In addition, subjects contracted to observe and record the exercise of other subjects and to perform an independent reliability observation once each week, with both of these activities monitored by the experimenters. Results indicated that the contract contingencies produced increases in the number of aerobic points earned per week for seven of eight subjects, that the aerobic point system possesses several advantages as a dependent variable for behavioral research on exercise, and that inexperienced observers could be quickly trained to observe exercise behavior and to translate those observations into their aerobic point equivalents. Finally, in a followup questionnaire completed 12 months after the end of the study, seven of the eight subjects reported that they were earning more aerobic points per week than had been the case during the baseline condition of this experiment.     

MODIFICATION OF ACTIVITY LEVEL THROUGH BIOFEEDBACK AND OPERANT CONDITIONING1

The biomotometer, an electronic device that simultaneously measures activity and provides auditory feedback to the subject, was used in combination with material reinforcers in two experiments attempting to modify activity level in children. In the first study the activity level of an 11-year-old highly active boy was decreased below mean baseline during conditioning in a classroom setting. His level of activity returned to baseline when feedback was withdrawn. In the second study, activity level of a 10-year-old hypoactive boy was increased over mean baseline level during conditioning in a free-play setting, and returned to slightly below baseline during five extinction trials. Results of these studies indicate that the biomotometer is a useful instrument for modification of activity level.     

BEHAVIORAL RESEARCH IN PREVENTIVE DENTISTRY: EDUCATIONAL AND CONTINGENCY MANAGEMENT APPROACHES TO THE PROBLEM OF PATIENT COMPLIANCE

This study examined the effects of reinforcement on compliance with an oral hygiene education program. Patients 18 years of age or older who enrolled in an ongoing program at a periodontal practice received 3–5 sessions of instruction in preventive dental care. Using a between-subjects design, patients who entered the program during alternating months also had a portion of their fees refunded contingent upon improvements in their dental plaque scores. Pre- and posttreatment data showed that all subjects exhibited lower plaque levels following the program, but that greater improvements were seen in patients who were exposed to the fee reduction contingency. Plaque scores taken at a 6-month follow-up revealed some relapse for the Fee Reduction subjects. However, their scores were still substantially better than pretreatment, and better than those of the Education only subjects, whose data differed little from untreated Controls. Methodological and practical issues related to behavioral research in preventive dentistry are discussed.     

BEHAVIORAL ASSESSMENT AND TREATMENT OF CHRONIC FOOD REFUSAL IN HANDICAPPED CHILDREN

In this study, we examined the eating behavior of four handicapped children, none of whom exhibited self-feeding skills. All children had a history of food refusal and were nutritionally at risk; one child received all nourishment by way of a gastrostomy tube. Baseline data taken during mealtimes indicated that all children accepted very little food, expelled food frequently, and engaged in a number of disruptive behaviors. Treatments consisted of one or more of the following contingent events: social praise, access to preferred foods, brief periods of toy play, and forced feeding. Results of multiple-baseline and reversal designs showed marked behavioral improvement for each child and increases in the amount of food consumed. Further improvements were noted at follow-up, which ranged from 7 to 30 months posttreatment.     

铁路装卸系统人力资源组合的研究

依据管理心理学的理论提出了人力资源优化组合的两阶段假设,使之形成可控制的操作程序。在铁路苏州装卸车间进行实验处理并选择情况相似的Ｎ站为比较组。实验前后苏州装卸车间和比较组之间都发生了明显的变化,运用《班组群体社会心理气氛调查表》测试职工的成就感、温暖感、舒适感等心理感受与劳动态度有关因素的认知水平等各项指标实控两组都有较其显著性差异。优化组合的企业职工的经济收入有了较大幅度地增加,企业的社会效益和经济效益明显提高。     

CLINICAL BEHAVIORAL PHARMACOLOGY: METHODS FOR EVALUATING MEDICATIONS AND CONTINGENCY MANAGEMENT

We evaluated methods for comparing the effects of dextroamphetamine (Dexedrine), thioridazine (Mellaril), and contingency management in the control of severe behavior problems. A reversal design was used in which medications were systematically titrated and assessed in unstructured as well as structured settings with three clients. Subsequently, behavioral procedures including timeout, differential reinforcement of other behavior, and visual screening, were used in a multiple-baseline design across settings. The assessment and design methods were useful in comparing the interventions. Dextroamphetamine decreased inappropriate behaviors and improved academic behaviors in one client, but no reliable effects were observed in the other two clients. Thioridazine was variable across clients, settings, behaviors, and dosages. Contingency management produced consistent decreases in inappropriate behaviors and small improvements in academic performance.     

VISITING THE DENTIST: A BEHAVIORAL COMMUNITY ANALYSIS OF PARTICIPATION IN A DENTAL HEALTH SCREENING AND REFERRAL PROGRAM

One-hundred and twenty-five families in the Medicaid Early Periodic Screening, Diagnosis and Treatment Program were assigned to one of five treatments to encourage parents to obtain health care service following the dental screening of their children: (a) a control procedure, in which parents were given a dentist's name; (b) a multiple contact procedure, in which parents received a postcard and two telephone call reminders; (c) a problem-solve procedure, in which a social worker aide conducted a brief session with the parent; (d) an incentive procedure, in which parents selected among four gifts that were contingent on seeking care; (e) an incentive + problem-solve procedure, in which the latter two treatments were combined. The multiple contact, incentive, and incentive + problem-solve techniques were significantly more effective in initiating dental visits than the control procedures. Families assigned to the intensive strategies were most likely to complete treatment. A cost-efficiency analysis showed the multiple contact technique to be a low-cost and highly effective procedure.     

AN EVALUATION OF THE ELECTRONIC FETAL MONITOR AS A FEEDBACK DEVICE DURING LABOR

We describe new methodology for the evaluation of the labor experience and preliminary findings using these methods. The effects of feedback from an Electronic Fetal Monitor on report of contraction onset were evaluated during the labors of eight primiparous women, four of whom had attended childbirth preparation classes. Using a within-subject reversal design, data were gathered across four phases for each woman: no feedback (monitor turned away from mother and coach), feedback, no feedback, and feedback again. The women were observed in early labor without medication. Six women were able to note the onset of contractions earlier with the availability of feedback; two women (who had not attended childbirth preparation classes) were more variable in their response. Threshold for recognition of pain onset did not change reliably. Seven of the eight women chose to continue monitoring when offered the chance to discontinue it. These results suggest that the technological advance of fetal monitoring can be used in cooperation with prepared childbirth techniques to facilitate earlier recognition of contraction onset, allowing increased preparation for contractions. Further experimental evaluations during labor are suggested.     

LETTING A LITTLE NONVERBAL AIR INTO THE ROOM: INSIGHTS FROM ACCEPTANCE AND COMMITMENT THERAPY PART 2: APPLICATIONS

Acceptance and Commitment Therapy (ACT) and Rational-Emotive Behavior Therapy (REBT) seem to have much in common. For example, they both seek to increase client’s willingness to accept inevitable, unpleasant experience. However, the techniques the therapies use to increase acceptance are often quite different. Building on the philosophical and theoretical framework presented in the previous paper, we discuss the major practical differences between ACT and REBT. We then suggest some concrete ways that the two approaches can be integrated. Such integration may greatly expand the sorts of techniques that a therapist can effectively use in the therapy room. Address correspondence to Joseph Ciarrochi, Department of Psychology, University of Wollongong, Wollongong, NSW 2522, Australia     

THE ROLE OF FEEDBACK IN VOLUNTARY CONTROL OF BLOOD PRESSURE IN INSTRUCTED SUBJECTS1

Forty normal male volunteers were randomly assigned to one of four experimental conditions and instructed to raise and lower their systolic blood pressure. Subjects received either beat-to-beat feedback contingent on pressure changes, noncontingent beat-to-beat feedback, noncontingent feedback presented randomly with respect to the occurrence of each heart beat, or instructions alone. The order of increase and decrease trial blocks was counterbalanced across groups. Subjects receiving contingent feedback were monetarily rewarded for appropriate pressure changes. Subjects receiving noncontingent feedback received rewards and feedback equal to the mean received by the contingent group. Subjects in the instructions-only condition were also paid this bonus but were informed of their earnings only at the conclusion of the experiment. Results indicated that in the presence of instructions, feedback, whether contingent or noncontingent, added little to subjects' ability to control pressure during a single session. Theoretical and clinical implications are discussed.     

USE OF TEXTURE FADING IN THE TREATMENT OF FOOD SELECTIVITY

Children with feeding disorders often display severe food selectivity. For many of these children, consuming highly textured foods may be aversive or potentially dangerous because of frequent gagging. The purpose of this study was to demonstrate the efficacy of texture fading in the treatment of food selectivity displayed by 4 children. Treatment involved the gradual addition of higher textures based on the results of periodic probes. In addition, food acceptance and swallowing were reinforced, while food refusal and food expulsion were placed on extinction. Results showed that all participants successfully advanced to consumption of age-appropriate texture and volume. The results suggest that texture fading with intermittent probes at higher textures may be an effective method for the treatment of food selectivity by texture.     

INDUCTION AND MAINTENANCE OF SWALLOWING RESPONSES IN INFANTS WITH DYSPHAGIA

A treatment package was used to induce and maintain swallowing with three infants who did not swallow food or liquid. Prior to treatment, they received all nutrition and hydration via gastrostomy tube feedings. The treatment package consisted of least-to-most intrusive physical prompts, an eliciting stimulus, contingent social reinforcement, and repeated trials to induce and maintain swallowing. The design combined elements of reversal and changing criterion designs for all three infants. The package was applied across feeding devices (nipple, cup, spoon), situations (liquid, pureed foods), and persons (trainer, primary nurses, mothers). The number of swallows or ounces per feeding (from 0 to 8 ounces) and the number of feeding sessions per day (from one to five) were progressively increased. In each case, the infant received baseline conditions alternated with the treatment package. Follow-up probes were done at 15 months, 21 months, or 24 months, respectively, after the last phase for the three patients. The package was successful in that the gastrostomy tube was no longer needed for Patients 1 and 3. Patient 2 maintained functional swallowing responses but received supplemental gastrostomy feedings because of unrelated medical problems. Results are discussed in terms of the need to isolate components of the package. The package can be used in cases in which the preexisting treatments (reinforcement with preferred foods, force-feeding) are not feasible because of age, physical fragility, or the lack of a swallowing response following the presentation of food.     

OPERANT TREATMENT OF OROFACIAL DYSFUNCTION IN NEUROMUSCULAR DISORDERS

The popularity and reported success of biofeedback treatment for neuromuscular disorders has occurred despite a lack of research identifying the critical variables responsible for therapeutic gain. In this study, we assessed the degree to which severe neurological dysfunction could be improved by using one of the components present in all biofeedback treatment, contingency management. Three cases of orofacial dysfunction were treated by reinforcing specific improvements reliably detectable without the use of biofeedback equipment. The results showed that contingency management procedures alone were sufficient to improve overt motor responses but, unlike biofeedback treatment, did not produce decreases in the hypertonic muscle groups associated with the trained motor behavior. The findings suggest that sophisticated, expensive biofeedback equipment may not be necessary in treating some neuromuscular disorders and that important clinical gains may be achieved by redesigning the patient's daily environment to be contingently therapeutic, rather than only accommodating the disabilities of the physically handicapped.     

ISSUES AND IMPLICATIONS OF ESTABLISHING GUIDELINES FOR THE USE OF BEHAVIORAL TECHNIQUES

Several guidelines surrounding the use of behavioral procedures have recently appeared, the best of which is that of the National Association of Retarded Citizens (NARC). Some issues and implications of the establishment of guidelines are briefly reviewed in the context of the NARC guidelines. Issues include the factual versus opinion bases for guidelines and the need to continue the development of explicit behavioral criteria for assessing staff competence. Implications for programs include the impact of guidelines on professional boundaries, administrative decision-making, and budgeting, together with the dangers of expanding the regulatory bureaucracy. Several miscellaneous impacts are noted, including a potential for curbing innovative behavioral technology.     

ASSESSING AND TRAINING TEACHERS IN THE GENERAUZED USE OF BEHAVIOR MODIFICATION WITH AUTISTIC CHILDREN1

This study investigated the feasibility of developing reliable, valid criteria for measuring and training the skills necessary to teach autistic children. The behaviors of 11 teachers and 12 autistic children were recorded in a series of different teaching situations. Teacher-training was initiated at different times for different teachers. The results showed: (1) it was possible to assess empirically whether a teacher was correctly using defined behavior-modification techniques; (2) generally, for any given session, systematic improvement in the child's behavior did not occur unless the teacher working in that session had been trained to use the techniques to a high criterion; (3) all 11 teachers were rapidly trained to use these techniques; and (4) the teachers learned generalized skills effective with a variety of children and target behaviors.     

THE MANAGEMENT OF DEHYDRATION AND INCONTINENCE IN NONAMBULATORY GERIATRIC PATIENTS

We evaluated a health care routine designed to decrease incontinence and improve the hydration level of nonambulatory nursing home patients. To implement this routine, a 3′ × 4′ cart was equipped with liquids and toileting equipment. A nurse's aid was assigned the task of taking the cart to each nonambulatory resident in a nursing home and offering specified assistance on a regular basis. Data demonstrated a decrease in physical dehydration, as well as in fecal and urinary incontinence.     

THE DEVELOPMENT OF CORRECT TOOTHBRUSHING TECHNIQUE IN PRESCHOOL CHILDREN

This study examined the effects of an intensive training program on the toothbrushing skills of three preschool children, using both performance measures and outcome (plaque level) indicators. Toothbrushing was broken into 16 steps that involved actual manipulation of the brush in the mouth. Correct brushing included four criteria: (a) appropriate angle of bristles, (b) appropriate motion of brush, (c) appropriate tooth surface, and (d) minimum duration of brushing. Training included instructions, a three-phase modeling procedure, physical guidance, and reinforcement. Results of a multiple baseline design across subjects showed that the children completed an average of 8.6% of the steps prior to training, as compared with an average of 95.8% of the steps following training. Plaque levels decreased from an average of 58% during baseline to 24.6% after training. Follow-up measures revealed that 86.6% of the steps were maintained. The study demonstrated that the effectiveness of the procedures in teaching very young children a complex motor skill that is essential to their future health.