Application of operant procedures in a group of institutionalized aggressive geriatric patients

This study used positive reinforcement schedules versus no reinforcement on a group of 6 highly aggressive, institutionalized elderly patients. Dependent measures included confirmed incidents of physical and verbal aggressive behavior monitored across an ABAB design with a 4-month phase-out period. Results indicated that aggressive behavior can be significantly decreased in a group setting and subsequently generalized to ward behavior. Ancillary aspects of the study included the role of tangible and back-up reinforcers and staff attitude and behavior. Implications for future research are discussed.     

Aggressive encounters between patients and general hospital staff: Staff perceptions of the context and assailants' levels of cognitive processing

A considerable body of research has accumulated regarding aggression toward health care staff, yet little is known about the contextual factors involved. The present study examined the context within which aggressive incidents occurred and the dynamics of the interaction between staff and patients. Two aspects in particular were investigated; firstly, whether incidents were preceded by some anxiety provoking stimulus and secondly, the assailants' levels of cognitive processing apparent at the time of the incident. A prospective study collected data concerning incidents of physical assault and threatening behaviour in a general hospital. Staff were interviewed soon after the incident occurred. A content analysis determined that 82.8% of incidents involved experiences delivered by the staff victims likely to have provoked anxiety in the assailant. Most commonly, incidents involved staff intervening in the patient's intended behaviour. In addition, in 64% of cases, assailants were actually displaying some impairment in cognitive processing at the time of the incident Data suggest that many patients may not have been fully aware of their situation and might have experienced some difficulty in comprehending the staff member's actions. Patients who do not appear to understand what is happening may require additional time and effort to ensure they comprehend fully and accept what the staff member is intending to do, particularly if patients are experiencing an event likely to increase anxiety levels. Aggr. Behav. 30:534–543, 2004. © 2004 Wiley‐Liss, Inc.     

Situational determinants of inpatient self-harm

Auto-aggressive individuals have a higher likelihood of engaging in interpersonal violence, and vice versa. It is unclear, however, whether ward circumstances are involved in determining whether aggression-prone patients will engage in auto-aggressive or outwardly directed aggressive behavior. The current study focuses on the situational antecedents of self-harming behavior and outwardly directed aggression of psychiatric inpatients. Inwardly and outwardly aggressive behavior were monitored on a locked 20-bed psychiatric admissions ward for 3.5 years with the Staff Observation Aggression Scale-Revised (SOAS-R). A map of the ward was attached to each SOAS-R form, enabling staff members to specify locations of aggressive incidents. Time of onset, location, and provoking factors of auto-aggressive incidents were compared to those connected to aggression against others or objects. Of a total of 774 aggressive incidents, 154 (20%) concerned auto-aggressive behavior. Auto-aggression was significantly more prevalent during the evening (i.e., 50% compared to 32%), and reached its highest level between 8 and 9 P.M. (17% compared to 7%). The majority of self-harming acts (66%) were performed on patients' bedrooms. Outwardly directed aggression was particularly common in the day-rooms (24%), the staff office (19%), the hallways of the ward (14%), and the dining rooms (10%). Provoking factors of auto-aggressive behavior are less often of an interactional nature compared to outwardly directed aggression. The results suggest that a lack of stimulation and interaction with others increases the risk of self-injurious behavior. Practical and testable measures to prevent self-harm are proposed.     

Application of social skills training in a group of institutionalized aggressive elderly subjects

A social skills training program consisting of instructions, modeling, role playing, and feedback was carried out with a group of 6 verbally aggressive institutionalized elderly patients. Dependent measures included confirmed incidents of verbal aggressive behavior monitored across an ABAB design with a 5-month follow-up period. Results indicated that verbally aggressive behavior can be significantly decreased in a group-training setting and subsequently generalized to ward and other socialized behavior. Ancillary aspects of the study include the role of social reinforcement, participant modeling, and staff attitude, perception, and motivation. Implications for future research are discussed.     

The staff observation aggression scale–revised (SOAS‐R)

Proper assessment of aggressive behavior is essential for an understanding of its causes. In 1987, Palmstierna and Wistedt [Acta Psychiatr Scand 76:657‐663] introduced the Staff Observation Aggression Scale (SOAS), an instrument for monitoring the frequency, nature, and severity of aggressive incidents. In the present study, the validity of the SOAS severity scoring system was examined, and the severity scores were refined. The SOAS was used to record aggression on six closed wards of three psychiatric hospitals. The SOAS severity scores of 556 aggressive incidents were compared with severity estimates given on Visual Analogue Scales (VASs) by staff members. The original SOAS scores were found to be moderately correlated with the estimates of severity given by staff on the VAS. The SOAS severity scoring system was refined on the basis of the staff severity estimates. The revised scoring method and other refinements in the contents of the instrument led to the construction of the SOAS‐R. The SOAS‐R seems to be a promising tool for monitoring a wide range of (self‐) destructive acts on psychiatric wards. Aggr. Behav. 25:197–209, 1999. © 1999 Wiley‐Liss, Inc.     

Unintentional Injury Risk in Children with Externalizing Behavior Disorders at Summer Camp

Children with externalizing behavior disorders such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) have greatly increased risk of unintentional injury, but it is unclear what mechanisms are responsible for that increased risk. This study followed 22 children participating in a summer camp for children with ADHD. Injury incidents were recorded daily and a set of primary symptoms of behavioral disorders were recorded at 15-min intervals over the course of the 6-week summer camp experience (roughly 300 h of observing each child). We predicted symptoms of ODD and CD would be more strongly related to injury incidence than symptoms of ADHD. Results from univariate Poisson regression models confirmed our prediction. Symptoms of ODD and CD—violations and intentional aggression in particular—were related to injury incidence but symptoms of ADHD were not. This finding is consistent with a growing body of evidence that oppositional, noncompliant, and aggressive behavior patterns might be primarily responsible for increased risk for injury among children with externalizing behavior disorders. Thanks to Sylvie Mrug, Peter Winslett, and the other staff members of the STP camp for their cooperation.     

Predictive validity of the Dutch PCL:YV for institutional disruptive behavior: findings from two samples of male adolescents in a juvenile justice treatment institution

The present prospective study examined the predictive validity of the Dutch version of the Psychopathy Check List: Youth Version for disruptive behavior in male adolescents during treatment. The study comprised two samples admitted to different secure treatment institutions in The Netherlands, Jongerenhuis Harreveld (n = 81) and Rentray (n = 66). Overall, the results demonstrate that psychopathy is a significant predictor of institutional disruptive behavior, and physical violence in particular. Furthermore, Hare's traditional Factor 2 was more strongly related to disruptive incidents than Factor 1. By using the recently proposed three- and four-factor models of psychopathy, insight into the pattern of associations between psychopathy dimensions and different types of disruptive behavior was obtained. The antisocial dimension of psychopathy appeared to be more strongly related to severe incidents than the lifestyle dimension. Regression analyses identified significant contributions of the antisocial and lifestyle dimensions to the prediction of incidents. The relatively small degree of variance explained underlines the importance of other risk factors to identify adolescents at risk of disruptive behavior during institutional treatment.     

Psychiatric nurses' experiences with inpatient aggression

Using a survey instrument, the experiences of psychiatric nurses with inpatient aggression were investigated in East London, U.K. On this “Perceptions of Prevalence Of Aggression Scale” (POPAS), annual experiences with 15 types of disruptive and aggressive behavior were rated anonymously. Staff members were also asked to disclose the number of days missed from work due to inpatient violence. On the basis of these POPAS forms, internal consistency of the instrument, mean reported aggression frequencies, and days missed from work due to violence were calculated. Internal consistency of the POPAS appeared to be reasonable. Verbal abuse and threats were experienced by most of the psychiatric nurses during a one‐year period (i.e., by about 80–90 percent of nurses). Sexual harassment or intimidation was also experienced relatively often on an annual basis (68 percent), particularly by female and young staff members. A minority of staff members (i.e., 16 percent) had experienced severe physical violence. Although not prevalent, this type of behavior was most strongly connected with reporting sick. In particular, staff members working with involuntarily admitted patients experienced much (severe) violence during their work. Although the validity of estimates of aggression prevalence with the POPAS instrument needs to be investigated further, such a survey may be helpful in gaining insight rather quickly into the level of day‐to‐day contact with aggressive behavior. Also, since information on verbal, physical, and sexual violence, and on days missed from work, can be provided anonymously, this rather delicate, but essential management information, may be accessed relatively easily with the POPAS. Aggr. Behav. 00:000–000, 2005. © 2005 Wiley‐Liss, Inc.     

Violence in the community—a study of violence and aggression in homelessness and mental health day services

This study examined violence and aggression in five agencies providing day services in homelessness or mental health. Incident reporting was used to test the hypotheses that aggression is associated with alcohol problems, drug use, mental disorder, homelessness, history of violence, age and sex. Agency policies and patterns to aggressive incidents were explored. Three agencies provided a sufficient number of incidents for analysis (involving 30 ‘aggressors’). A history of violence was associated with aggression in all three agencies; alcohol problems, drug use and younger age were associated with aggression in at least one agency; no association was found for mental disorder, homelessness or sex. A degree of pattern to incidents could be discerned, with drink or drugs often involved, and exercises of authority or intervention in client altercations being particularly likely to precede aggression towards staff. A variety of incidents were reported, from verbal arguments to threats with a knife and serious physical assault. © 1997 John Wiley & Sons, Ltd.     

What's the point? Towards a methodology for assessing the function of psychiatric inpatient aggression

There are few examples in the literature of the application of functional analysis to psychiatric inpatient aggression. Structural assessment approaches have dominated. This paper introduces a system for classifying the functions of aggression in psychiatric inpatients that was applied to 502 aggressive behaviours exhibited by patients in a secure forensic psychiatric hospital. At least one function was identified for the majority of aggressive incidents; the most common functions pertaining to patients' responses to the restrictions and demands of the inpatient setting, to express anger or to punish others perceived as provocative, and to maintain status. There was little evidence suggesting that aggression was used to obtain tangible rewards, to reduce social isolation, or to simply observe the suffering of others. Differences in the function of aggressive behaviour were found across victim types. Results of this study have implications for the prediction and prevention of inpatient aggression and for the treatment of aggressive inpatients.     

日常环境中的暴力暴露对攻击行为的长期影响:一个有调节的中介模型

以850名大学生为被试,探讨日常环境中的暴力暴露与攻击行为的关系,并在此基础上提出一个有调节的中介模型,考察攻击性信念的中介作用和人际信任的调节作用。结果发现:(1)日常环境中的暴力暴露对攻击行为有显著的正向预测作用;(2)攻击性信念在日常环境中的暴力暴露与攻击行为的关系中起部分中介作用;(3)攻击性信念的中介作用会受到人际信任的调节。对于低人际信任个体,攻击性信念起部分中介作用;对于高人际信任个体,攻击性信念的中介效应不显著,日常环境中的暴力暴露对攻击行为只有直接作用。     

Lay Definitions of Violence among Swedish Children,Teenagers, and Adults

Definitions of violence vary and are almost always operationalized by the researcher. Perceptions of violence often determine levels of tolerance of violence. Little research has focused on lay definitions. A total of 309 Swedes (78 children, 85 teenagers, 99 younger adults, and 47 adults (30+); 48% male) were interviewed using a specially developed interview protocol. Content analysis was used to assign definitional categories. A folk taxonomy emerged. Immediate physical violence accounted for 73% of all assigned categories. Hit was the word that occurred most frequently. If global physical violence was included, physical violence accounted for 89% of 780 assigned categories. Immediate non-physical violence accounted for 9% and vicarious violence (including media violence) accounted for 2%. Distributions of categories by respondents' gender, age, and participant role in incidents of violence showed the underlying definitions of violence to be extremely stable. The conclusion is that ordinary Swedes share a robust lay definition of violence as a behavior that is immediate, done in close quarters, and physical.     

The collateral effect of compliance training on aggression

This study represents a report on unexpected positive collateral benefits in the reduction of aggression. The treatment, for compliance across three classes of requests, resulted in the spontaneous reduction in non-targeted aggressive behavior across settings and time. An institutionalized adult male who was severely retarded and chronically aggressive served as the subject. Archival investigator- and facility staff-generated reports of aggressive episodes, based upon an operational definition in use for over a year at the time of the study, were used as dependent measures. A withdrawal design was used to demonstrate the collateral treatment effects upon aggression. The subject received positive treatment for his noncompliance within a multiple baseline across behavior classes design. Fifteen requests were presented to the subject in random order during each treatment session, compliant behavior was reinforced using praise and physical contact. Results of the compliance training showed immediate and marked increases in compliance with a collateral decrease in the incidents of aggression. While aggression increased during the nonintervention follow-up phase of the study, it remained significantly lower than baseline levels.     

The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital

The widespread use of seclusion and restraint in child psychiatric hospitals to manage aggression and noncompliance is based on the assumption that coercive consequences reduce the frequency of undesirable behaviors exhibited by the patients. We report a study of the use of seclusion and restraint in a public child psychiatric hospital during a 3-year period. Twenty-eight percent of the patients had been secluded or restrained a total of 1670 times. About 25% of these patients had been secluded more than five times during their hospitalization, and 32% had been placed in restraints more than once. Behaviors that typically resulted in repeated seclusion included physical aggression toward staff, verbal aggression toward peers, non-compliant or oppositional behavior, and self-harm. Variables that predicted patients most at risk for repeated seclusion included age, gender, and psychiatric diagnosis. The predictor variables for those most at risk for repeated restraint included age, property destruction, and self-harm. The high rates of use of seclusion and restraint suggest that these methods for controlling the behavior of children and adolescents in this child psychiatric hospital may not have been therapeutic. We suggest that staff in such hospitals engage in a pattern of behavior characterized by an aggression-coercion cycle, in which increasingly aggressive and coercive behaviors are exhibited by both patients and staff.     

MMPI validity scales and behavioral disturbance in psychiatric inpatients.

Sixty psychiatric inpatients were assigned to one of three groups on the basis of F and K MMPI validity scales. Staff ratings of patient behavior and recorded incidents of "acting-out" behavior were obtained for patients with: (a) "plea for help" validity profiles, (b) hyper-defensive profiles, and (c) average profiles. Patients with "plea for help" profiles were perceived as "acting-out" more frequently and engendering more feelings of frustration than patients in the other groups. These patients account for 77% of the incidents of inappropriate, destructive behavior and 83% of the seclusions in the patients sampled. Although the "plea for help" profile is considered invalid in some scoring systems, results suggest that this validity profile may be useful in treatment planning.     

Validation of a Theory-Driven Profile Interpretation of the Dutch Short Form of the MMPI Using the TAT Social Cognitions and Object Relations Scale (SCORS)

Sixty psychiatric inpatients were assigned to one of three groups on the basis of F and K MMPI validity scales. Staff ratings of patient behavior and recorded incidents of "acting-out" behavior were obtained for patients with: (a) "plea for help" validity profiles, (b) hyper-defensive profiles, and (c) average profiles. Patients with "plea for help"profiles were perceived as "acting out" more frequently and engendering more feelings of frustration than patients in the other groups. These patients account for 77% of the incidents of inappropriate, destructive behavior and 83% of the seclusions in the patients sampled. Although the "plea for help"profile is considered invalid in some scoring systems, results suggest that this validity profile may be useful in treatment planning.     

身体攻击行为学生自主神经活动的情绪唤醒特点

运用情绪生理学的方法,以31名具有身体攻击行为的初中工读学生和30名普通初中生为研究对象,研究了身体攻击行为学生与普通学生在基线生理唤醒和情绪生理唤醒的方面不同特点。结果发现,在生理唤醒的基线水平上,身体攻击行为学生与普通学生在指温、R-R间期、心率、指脉率方面差异显著,身体攻击行为学生的指温、心率、指脉率比普通学生低,身体攻击行为学生的R-R间期比普通学生R-R间期长。在愤怒刺激条件下,身体攻击行为学生报告的愤怒体验水平比普通学生高;愤怒诱发刺激引起身体攻击行为学生R-R间期、心率变化显著,而普通学生R-R间期、心率变化不显著。厌恶与恐惧、悲伤、愉快诱发刺激引起普通学生皮肤电变化显著,而身体攻击行为学生皮肤电变化不显著     

Exploring definitions of bullying among personality disordered patients in a maximum‐secure hospital

The current study explored the perceptions of staff and patients concerning how patient‐to‐patient bullying should be defined and what behaviours it should include. Participants were randomly selected from the Personality Disorder Unit of a maximum secure hospital. A total of sixty interviews were conducted (30 staff and 30 patients). Problems in attempting to utilise definitions of bullying developed for use in other contexts, i.e., schools, were identified. Patients and staff presented with similar views about how it should be defined: both felt that aggression did not have to be repeated or severe in order to be classed as bullying, that bullying could be accidental, that the power imbalance between perpetrator and victim was not always explicit and, finally, that victims could provoke bullies unintentionally. Indirect (i.e. covert) forms of aggression were less likely to be considered bullying than direct (i.e. overt) forms. A number of differences were found between staff and patients regarding how bullying was conceptualised. Staff were more likely than patients to hold the belief that some patients liked being bullied, and appeared to acknowledge a broader definition of bullying than patients, accounting for a wider range of aggressive behaviours. A number of similarities between the current study and previous prison‐based research were found. The implications of these findings for current research and the value in attending to prison‐based research are highlighted. Aggr. Behav. 00:000–000, 2005. © 2005 Wiley‐Liss, Inc.     

Children’s Sympathy for Peers Who Are the Targets of Peer Aggression

Although a goal of many aggression intervention programs is to increase children's concern (often termed sympathy or empathy) for their peers as a means of ultimately reducing aggressive behavior, there are no measures specifically of children's concern for peers who are the targets of peer aggression. A participatory action research (PAR) model was used to create a culturally-sensitive measure of urban African American children's sympathy for peers who are the targets of physical aggression, relational or social aggression, verbal aggression, and property damage. In Study 1, 40 children (M (age)?=?9.71?years; 47.5 % female) were interviewed about the types of incidents that lead them to feel sympathy for a peer. Based upon these findings, the 15-item Peer Sympathy Scale (PSS) was developed. In Study 2, the PSS was administered to 517 children (M (age)?=?9.82?years; 47.4 % female) to examine the psychometric properties of the measure and to explore the association between children's sympathy for their peers and their social behavior. Greater sympathy was associated with less overt and relational aggression according to both peer and teacher reports as well as with less oppositional-defiant behavior according to teacher reports. The clinical utility of the PSS as an outcome assessment tool for social skills intervention programs is discussed.