Thought suppression and self-injurious thoughts and behaviors

This study proposes and tests a theoretical model suggesting that the propensity to suppress unwanted thoughts is associated with an increased presence and frequency of self-injurious thoughts and behaviors (SITB). In the model, propensity to suppress unwanted thoughts is hypothesized to be a cognitive mediator of the relationship between emotional reactivity and SITB, and is expected to be related to the extent to which SITB is initiated to escape from aversive emotions. Results of this cross-sectional study of adolescents (N=87) revealed that the self-reported propensity to suppress unwanted thoughts is associated with the presence and frequency of non-suicidal self-injury (NSSI), suicidal ideation, and suicide attempts. Furthermore, thought suppression partially mediates the relationship between emotional reactivity and the frequency of NSSI and suicidal ideation. Finally, adolescents with a higher tendency to suppress unwanted thoughts report engaging in NSSI in order to reduce aversive emotions rather than for social communication. Results are discussed within the framework of the negative reinforcement function of SITB.     

Personality traits in eating-disordered patients with and without self-injurious behaviors

Although there is a high comorbidity of eating disorder and self-injurious behavior (SIB), no systematic research has focused on personality trait differences in patients with and without SIB. In this study, a Dutch adaptation of the NEO-FFI (Costa & McCrae, 1985, 1992) was completed by 178 female, eating-disordered (ED) patients of whom 46.5% showed at least 1 form of SIB (e.g., cutting, burning, hair pulling). A subsample of 41 patients also completed the NEO-PI-R. Compared to patients without SIB, ED patients with SIB scored significantly higher on the Neuroticism scale and significantly lower on the Extraversion scale; on subtraits (facet scores) they appeared to be more anxious, more willing to please and less cheerful, efficient and ambitious. Personality traits were not associated with frequency or form of SIB or subtype of ED (except for impulsiveness). We also did not find a significant interaction effect between ED subtype and presence/absence of SIB.     

Case study: Noninvasive behavioral treatment of self-injurious hand stereotypy in a child with Rett syndrome

Treatment of stereotypic hand mouthing in a 3-year-old girl with Rett syndrome by differential reinforcement of competing functional responses plus response interruption is described and evaluated in this case study. A package of graduated guidance with social and edible reinforcers successfully established stable rates of functional hand movements to activate toys, gross motor responses to verbal prompts, palmar grasp and release, and some vocal imitation. Contingent response interruption virtually eliminated hand mouthing during instructional sessions. Instruction alone did not maintain hand mouthing suppression when interruption was withdrawn, and treatment gains appeared highly discriminated. Post-hoc comparison indicated differential reinforcement plus response interruption (DR1 + 1) to be superior to hand splints in reducing hand stereotypies, with approximately equivalent increases in collateral tongue thrusting.     

The emotion reactivity scale: development, evaluation, and relation to self-injurious thoughts and behaviors

Prior research has examined the relations between various facets of emotion and psychopathology, with a great deal of recent work highlighting the importance of emotion regulation strategies. Much less attention has been given to the examination of emotion reactivity. This study reports on the development and evaluation of the Emotion Reactivity Scale (ERS), a 21-item self-report measure of emotion sensitivity, intensity, and persistence, among a sample of 87 adolescents and young adults. Factor analysis revealed a single factor of emotion reactivity best characterized the data. The ERS showed strong internal consistency (alpha=.94), convergent and divergent validity via relations with behavioral inhibition/activation and temperament, and criterion-related validity as measured by associations with specific types of psychopathology and self-injurious thoughts and behaviors (SITB). Moreover, emotion reactivity statistically mediated the relation between psychopathology and SITB. These findings provide preliminary support for the ERS and suggest that increased emotion reactivity may help explain the association between psychopathology and SITB.     

Basing the treatment of stereotypic and self-injurious behaviors on hypotheses of their causes.

Stereotypic and self-injurious behaviors are common forms of maladaptive responding demonstrated by severely handicapped persons. Various review papers suggest that no single treatment procedure is universally effective. Although there may be many reasons for this finding, one could be that people engage in these behaviors for various reasons, and that procedures that are incompatible with the cause of the behavior are unlikely to be effective. These studies also suggest many hypotheses for the development and maintenance of these behaviors, three of which are the self-stimulation, positive reinforcement, and negative reinforcement hypotheses. The purpose of this paper was to determine whether one of these hypotheses could be matched to the cause of the behavior and used as an effective treatment procedure. We therefore compared one hypothesis with one other for 3 subjects in a three-phase study. During baseline, data were taken in two classrooms for each subject, and a judgement was made about the hypothesis most likely to be related to the cause of the behavior. During the second phase, a treatment based on that hypothesis was used in one classroom, and a treatment based on another hypothesis was used in the second classroom. During the third phase, the treatment that was most effective in the second phase was used in both classrooms. Results showed that a successful treatment program can be developed on an hypothesis of why the behavior occurred during baseline. Results are discussed in terms of supporting the argument that treatment programs should be based on a functional analysis of the behavior in its environmental context.     

Narratives of escape: A hermeneutic study of resiliency

This study examines the structure of narratives told by well-functioning adults who were at-risk as children. Participants told stories of their childhood based on pictures they selected from the TAT test (Thematic Apperception Test). Analysis of their narratives resulted in a set of hermeneutic rules which may be useful in interpreting the structure of narratives and in understanding the relationship between internalized images, reality construction, and resiliency. Two types of images were identified: negative images of stress and darkness and more positive images of escape and hope. Implications for helping clients develop images of strength and competence are discussed.The authors wish to thank an anonymous reviewer for his or her very helpful suggestions.     

Teacher escape,avoidance, and countercontrol behaviors: Potential resoponses to disruptive and aggressive behaviors of students with severe behavior disorders

We develop hypothese based on the research literature regarding behavioral responses to aversive stimuli. Specifically, escape, avoidance, and countercontrol responses are presented as teacher behaviors which may occur in the presence of disruptive and aggressive behaviors (aversive stimuli) which, in part, characterize many students with severe behavior disorders (SBD). The potential for teacher escape, avoidance, and countercontrol responses to the detrimental for both teachers and students is presented, as well as suggestions for addressing aversive behaviors of students in ways to reduce the potential detrimental impact.     

The influence of activity choice on problem behaviors maintained by escape versus attention

This study assessed whether the function of an individual's problem behavior was related to the effectiveness of an intervention involving choice among tasks. Analogue functional analyses were conducted with 7 students with various diagnoses to determine whether problem behaviors were maintained by escape or attention. Following identification of the function of each student's problem behavior, reversal designs were used to assess the effectiveness of an intervention that allowed the students to choose their own instructional tasks. Results showed that students who displayed escape-maintained problem behavior showed substantial reductions in such behavior when they were provided with opportunities to choose among tasks. On the other hand, students who displayed attention-maintained problem behavior did not show any effects as a result of the choice intervention. These findings are discussed in terms of the effective use of behavior management programs involving choice and the reduction of problem behavior.     

Identifying health-seeking behaviors: a study of adolescents

While it is known that health-seeking behaviors are influenced by information-seeking behaviors, reported research on adolescents' information-seeking behaviors is minimal. Available definitive information primarily addresses ways in which peers, parents, and health professionals are used as sources of information concerning sexuality. Research is now needed on how adolescents use the media and other sources of health information to effect changes in their lives. The present study sought to determine how adolescents' health-seeking behaviors, which include self-management and information-seeking behaviors, differ according to age, race, socioeconomic status, gender, and religion. The study was based on two assumptions: Self-management and information-seeking behaviors are fundamental to adolescents' health-seeking behaviors, and subjects answer self-management and information-seeking questions in terms of past behaviors and their behavioral intent. Important findings that emerged from this investigation include confirmation of gender as a differentiating variable for the performance of information-seeking behavior and positive health behaviors among black adolescents. Further, subjects reported an overall positive composite of health-seeking behaviors.     

Made to escape: How the neoliberal rationality changed consumer escape

Current research on consumer escape is characterized by a paradox: when seeking to escape the structures, pressures, and obligations of modern life, consumers end up reinforcing the same structure that caused the desire to escape. We propose that this paradox can be explained by a connection between consumer escape and the neoliberal rationality, which is understood to focus on the creation of autonomous, ambitious, and aspiring individuals. Thus, in this article, we explain how the neoliberal rationality affects consumer escape. A three-year ethnography in a community of long-distance runners has enabled us to explain that the neoliberal rationality acts on consumer escape through three specific and interdependent dynamics: the community of performance, the entrepreneurial body, and the performance market. Together, those three dynamics change the nature of consumer escape experiences in our contemporary society, according to the main contribution of this research.     

Partial negative reinforcement: fixed-ratio escape

Rats were unable to sustain performance when eight bar-presses turned off shock (−FR 8). In a second experiment, thirsty rats were able to maintain a moderate response rate when performance on −FR 8 was also reinforced with water. Some rats continued to bar-press on −FR 8 after withdrawal of positive reinforcement, but at a much lower rate. A possible explanation of the results is that during intermittent escape conditioning in a free-responding situation the absence of shock itself acquires aversive properties.     

Adolescent non-suicidal self-injurious behavior: The latest epidemic to assess and treat

Non-suicidal self-injury (NSSI) among adolescents is a serious and prevalent problem. This article reviews the epidemiological data as well as the existing treatments for adolescents who engage in NSSI. The authors also present the unique features of dialectical behavior therapy, the gold-standard evidence-based treatment for adults who engage in NSSI, and discuss its promise as an effective treatment for adolescents who engage in NSSI. Finally, the authors present a clinical vignette of an adolescent engaging in NSSI and how DBT works to target this maladaptive behavior.This article reviews first the epidemiological data and then the existing treatments for adolescents engaging in non-suicidal self-injurious behavior (NSSI). Next, the authors present the unique features of one particular therapy, called dialectical behavior therapy, for adolescents who engage in NSSI. Finally, the article concludes with a clinical vignette in which dialectical behavior therapy is applied to an adolescent engaging in NSSI.     

Case study: Research with brain-dead children

The esophageal obturator airway (EOA) is a device used throughout the United States to facilitate artificial respiration of critically ill patients who are not hospitalized. Its use is restricted to persons who are over 15 years old because obturators for children are not available. A protocol submitted to an institutional review board (IRB) intended to develop EOAs suitable for use in children. The investigators proposed to perform preliminary testing of these devices on children who had sustained irreversible loss of brain function (“brain death”). In its review of this protocol, the IRB had to confront several vexing questions.