Independent and Interdependent Group Contingencies

Abstract

Independent and interdependent group contingencies have many applied advantages for influencing behaviors in school settings, However, there are negative side effects associated with these group oriented contingencies. A scenario is presented that illustrates some negative side effects of independent and interdependent group oriented contingencies. Specific recommendations for altering group oriented contingencies to reduce these negative side effects and increase the probability that teachers will use these contingencies to increase students' academic performance and prosocial behaviors follows the scenario.     

The role of additional information in the compliance,satisfaction, psychological,and emotion responses of non-surgical patients with low back pain: An exploratory investigation

Abstract

Noncompliance and the psychological and emotional states of patients with low back pain are major concerns for health professionals. The current study evaluated whether amount of information available to patients enhanced compliance to a medical regimen and whether it reduced negative emotions in patients with low back pain. Forty-five orthopaedic non-surgical patients with low back pain were randomly assigned to one of three information presentation conditions: 1) Standard, 2) Pre-examination, and 3) Post-examination. Patients were also separated by compensation and noncompensation within each information group. Patients completed questionnaires at their initial visit and at their follow-up which evaluated their: levels of compliance to a prescribed treatment program, psychological, and emotional states. Results indicated that some patients benefitted from receiving additional information as the Pre-examination and Post-examination groups demonstrated superior comprehension and recall as well as higher levels of compliance to a physical therapy program. In addition, compensation patients complained of more negative psychological and emotional behaviors in comparison to noncompensation patients. Implications of the research and future research considerations were discussed.     

Follow-up results of a cognitive-behavioural treatment for chronic pain in a primary care setting

Abstract

An outpatient cognitive-behavioural treatment programme for pain control was administered to chronic pain patients in three primary care practices with a medical psychologist as a group therapist. The patients suffered from headaches, migraines, cervical pain, shoulder-arm pain, and low back pain. A matched sample of patients with the same disorders served as a waiting-list control group. The programme consisted of training in progressive muscle relaxation, several attention related techniques, and cognitive restructuring as well as reinforcing non-pain behaviour, and aimed at an improvement of self-control strategies. At the six month follow-up, the treated subjects showed improvements in their average scores of anxiety, depression and bodily symptoms compared with the untreated controls. Pain intensity was reduced by 34% in those subjects (9 out of 25) who were most adherent to the treatment regimen. Our results indicate a long-term improvement in well-being as a consequence of the treatment. This was confirmed by the ratings of the physicians and by the reduced number of patient-physician contacts three months post treatment as compared to the controls. Treatment adherence seems to be a most important agent in maintaining long-term reductions of pain intensity.     

Task-related and person-related variables influence the effect of low back pain on anticipatory postural adjustments

BackgroundPeople with low back pain exhibit altered postural coordination that has been suggested as a target for treatment, but heterogeneous presentation has rendered it difficult to identify appropriate candidates and protocols for such treatments. This study evaluated the associations of task-related and person-related factors with the effect of low back pain on anticipatory postural adjustments.MethodsThirteen subjects with and 13 without low back pain performed seated, rapid arm flexion in self-initiated and cued conditions. Mixed-model ANOVA were used to evaluate group and condition effects on APA onset latencies of trunk muscles, arm-raise velocity, and pre-movement cortical potentials. These measures were evaluated for correlation with pain ratings, Fear Avoidance Beliefs Questionnaire scores, and Modified Oswestry Questionnaire scores.FindingsDelayed postural adjustments of subjects with low back pain were greater in the cued condition than in the self-initiated condition. The group with low back pain exhibited larger-amplitude cortical potentials than the group without pain, but also significantly slower arm-raise velocities. With arm-raise velocity as a covariate, the effect of low back pain remained significant for the latencies of postural adjustments but not for cortical potentials. Latencies of the postural adjustments significantly correlated with Oswestry and Fear Avoidance Beliefs scores.InterpretationDelayed postural adjustments with low back pain appear to be influenced by cueing of movement, pain-related disability and fear of activity. These results highlight the importance of subject characteristics, task condition, and task performance when comparing across studies or when developing treatment of people with low back pain.     

Prospective payment: its impact on psychology's role in health care

This article describes the new Medicare payment system based on diagnosis-related groups (DRGs) and its impact on professional psychology. DRGs represent medically oriented notions about how many inpatient days a prudent physician needs to effectively treat a patient who suffers from a specified disease. However, for the most part, DRGs ignore the behavioral variables that moderate entry into the tertiary care system and the subsequent use of hospital resources. Under DRGs, the development and use of behavioral treatments for somatic disorders could be discouraged. For example, many newer behavioral medicine techniques may be more time-consuming and/or expensive than traditional treatment options (e.g., bed rest vs. biofeedback for low back pain) and thus not fall within the time period or "trim points" alloted for such disorder, regardless of comparative effectiveness. Also, under the new system, psychologists can no longer bill separately for their inpatient services. It is argued that the framers of health care policies should recognize and support health psychologists in light of the fact that many of their techniques can reduce the cost and consumption of health care through programs that: reduce behavioral risk factors, increase compliance with medical regimens, and prepare patients psychologically for stressful medical procedures.     

Use of verbal pain measurement in the detection of hidden psychological morbidity among low back pain patients with objective organic findings

Abstract

Patients with positive physical findings to explain low back pain arc believed lo belong to two organic subgroups. One group has organic disease alone: in the other, organic disease is accompanied by psychological disturbance. Separation of patients with medical findings into groups with varying levels of psychological disturbance is difficult, because emotional disturbance is often hidden. In this study, the pain report of 124 patients with organic findings alone, and 50 patients with organic and psychological findings was examined to determine whether pain measurement could he used to identify accurately patients belonging 10 the two groups. the pain groups differed in the use of 43 pain words from the Low Back Pain Symptom Check List. Using a set of weights derived From discriminant analysis. the 33 pain words predicted 99.2% of the patients with organic disease alone and 86.0% of the patients with organic disease and psychological disturbance. The results were replicated in a new sample of 140 patients. Cross-validation shrinkage in accuracy was 8.3%. The results of the two studies suggest that pain measurement may he a useful clinical indicator of psychological disturbance in patients with organic findings.     

Human behavioral momentum in a sample of older adults.

Behavioral momentum, the persistence of behavior under altered environmental contingencies, is derived from Newtonian physics and operant psychology. It has relevance to behavior analysis in terms of shaping strong behaviors and ensuring effective relapse prevention strategies in behavior modification and therapy. The authors investigated whether changing the operant schedule contingencies affects the responses of older humans to different stimuli when reinforcement density is systematically manipulated. Fifteen older adults participated in a computer study in which each of 2 keys in a baseline condition was associated with the same schedule of reinforcement and multiple variable intervals; the only difference was that 1 reinforcer was 10 times larger than the other. After 6 sessions, the authors changed the contingency schedule to either an extinction condition, a variable-time schedule, or a different variable-interval schedule, to assess how participants' responses persisted when reinforcement contingencies were systematically changed. The results were consistent with the predictions of behavioral momentum. The participants not only biased their responses in favor of the more densely reinforcing key, but when contingencies changed, they showed significantly biased responses. Results supported the conclusion that healthy older adults allocate their behaviors in a manner very sensitive to training stimuli conditions; consistent with the basic principles of behavioral momentum, they show a degree of resistance to change in their behaviors when the behavioral contingencies are altered.     

Treatment-related anxieties in children and adolescents with cancer

Abstract

Side-effects of anti-cancer treatment like nausea and vomiting and frightening medical procedures are relevant sources of anxiety in children and adolescents with cancer. Anticipatory nausea and vomiting can be described in terms of respondent conditioning. Hypnosis, systematic desensitization, relaxation training and employment of video-games are effective in mitigating these unpleasant concomitants of chemotherapy. Venipunctures, bone marrow aspirations, and lumbar punctures are repetitive painful procedures. Responses of pain and anxiety are ubiquitous, but still difficult to differentiate by psychological assessment. Rating scales and checklists have been developed to evaluate various intervention programs. Hypnotherapeutic approaches and comprehensive cognitive-behavioral treatment packages have been employed successfully to reduce anxiety reactions. In the future, it might be promising to match specific intervention programs with the coping behaviors spontaneously shown by the child; for instance, patients avoiding anxiety-provoking stimuli should be supported by additional distraction techniques, whereas vigilant patients that spontaneously focus their attention on these stimuli should be shown how to transform them in a positive context.     

Behavioral approaches to weight control: An updated review

Recent developments in the behavioral treatment of obesity were surveyed. Since the earlier review (Abramson, 1973) no studies of aversive therapy have been published. Three studies of covert sensitization have yielded discouraging results. Any positive effects of this technique appear to be the result of non-specific demand characteristics rather than aversive conditioning. Several demonstrations of the effects of therapist controlled reinforcement indicate that this technique can promote weight loss while the contingencies are in effect. The weight is rapidly regained, however, after the contingencies are withdrawn. It is concluded that self-control treatments, especially complex self-control, are the most consistently successful treatment approaches. Several methodological problems are presented and unresolved issues are discussed.     

Toward a functional analysis of delusional speech and hallucinatory behavior

An approach to a functional analysis of delusional speech and hallucinatory behavior is described and discussed using concepts found in Goldiamond's (1975a and 1984) nonlinear contingency analysis and Skinner's Verbal Behavior (1957). This synthesis draws upon and concords with research from the animal laboratory, with the extensive experimental literatures on stimulus control and signal detection theory, and with our own clinical experiences.In this formulation, delusional speech and hallucinatory behavior are viewed as successful operants. Accordingly, we argue that such behaviors can be considered adaptive and rational, rather than maladaptive and irrational, when analyzed within a model of consequential governance that includes alternative sets of contingencies. Several clinical examples are offered to illustrate both analytic procedures and the design of systemic treatment programs based upon a behavioral contingency analysis derived from a natural science of behavior. Throughout, we emphasize the consequential governance of these clinically important classes of behavior, in contrast to other approaches which suggest formal similarities to operant verbal behavior but largely ignore the role of consequential contingencies.     

Are complex psychotherapies more effective than biofeedback, progressive muscle relaxation, or both? A meta-analysis

A meta-analysis of 26 studies was conducted to assess whether more complex forms of psychotherapy would be superior to control treatments of either biofeedback, progressive muscle relaxation, or both. Consistent with hypotheses, more complex treatments provided a small, significant improvement over biofeedback and progressive muscle relaxation (r = .09). A subset of the more complex behavioral treatments accounted for most of this small incremental effectiveness of more complex treatments (r = .15). Possible sources of this incremental effectiveness are discussed.     

An experimental investigation of the effect of worry on responses to a discrimination learning task

The current study examined the impact of both the tendency to worry (trait worry) and the process of worry (state worry) on subsequent behavioral responding in a schedule discrimination learning task. High and low trait worriers were randomly assigned to a state worry or relaxation incubation condition and completed a test of executive functioning and a dual contingency learning task that utilized neutral discriminative cues over the course of 2 contingency phases. Although state and trait worry did not impact executive functioning, the state worry condition was associated with diminished sensitivity to learning task contingencies over the course of the first contingency learning trials in comparison to the relaxation condition. This relationship was unique to the state worry condition above and beyond shared variance with subjective anxiety level. Results suggest that state worry may lead to a decrement in selective behavioral responding to neutral discriminative cues in the environment. The findings suggest that the process of worry may lead to less adaptive responding to neutral cues and interfere with adaptive behaviors, which may thereby contribute to and maintain anxiety.     

Pragmatism,enactivism, and ecological psychology: towards a unified approach to post-cognitivism

This paper argues that it is possible to combine enactivism and ecological psychology in a single post-cognitivist research framework if we highlight the common pragmatist assumptions of both approaches. These pragmatist assumptions or starting points are shared by ecological psychology and the enactive approach independently of being historically related to pragmatism, and they are based on the idea of organic coordination, which states that the evolution and development of the cognitive abilities of an organism are explained by appealing to the history of interactions of that organism with its environment. It is argued that the idea of behavioral or organic coordination within the enactive approach gives rise to the sensorimotor abilities of the organism, while the ecological approach emphasizes the coordination at a higher-level between organism and environment through the agent’s exploratory behavior for perceiving affordances. As such, these two different processes of organic coordination can be integrated in a post-cognitivist research framework, which will be based on two levels of analysis: the subpersonal one (the neural dynamics of the sensorimotor contingencies and the emergence of enactive agency) and the personal one (the dynamics that emerges from the organism-environment interaction in ecological terms). If this proposal is on the right track, this may be a promising first step for offering a systematized and consistent post-cognitivist approach to cognition that retain the full potential of both enactivism and ecological psychology.

     

Stress Inoculation Training For Impulsive Behaviors In Adults With Traumatic Brain Injury

A stress inoculation training program involving relaxation, self-instructional, and coping skills training was delivered to 5 persons with traumatic brain injury in an attempt to reduce the frequency of their impulsive behaviors. A multiple-baseline across subjects design was utilized to evaluate the effectiveness of the 10-week intervention. Dependent measures included frequency of impulsive behaviors as recorded by staff members at the residential facility where all 5 participants resided, ratings of role-play-probes, effectiveness ratings by the participants' rehabilitation counselors, and interview information obtained from the participants and their counselors. The data showed a small, but consistent reduction in impulsive behaviors across the 5 participants. Additionally, results indicated changes in role-play ratings did not correspond to changes in in-vivo behavioral frequency recordings for 4 of the 5 subjects. These findings suggest that individuals with moderate to severe impairments may require more salient behavioral contingencies and consistent cuing procedures to control their impulsive behavior.     

Comment on "personality organization as an aspect of back pain in a medical setting".

The methodology and results of a recent investigation by Louks, Freeman, and Calsyn (1978) are reviewed. It is demonstrated that the results may have been confounded by inappropriate experimental procedures. Regardless of the methodological deficiencies associated with the experimental procedures, the results do not provide adequate support for the continued differentiation of individual low back pain patients with respect to the etiology of their pain. It is suggested that psychologists may best contribute to the assessment and treatment of individual pain patients by developing actuarial rules regarding the pain-related behavioral characteristics shared by members of various patient subgroups and the specific treatments to which subgroup members best respond.     

Das Reizdarmsyndrom

Irritable bowel syndrome is a common disorder that can be associated with significant disability and health care costs. Beyond it is the most common disease diagnosed by gastroenterologists. Diagnosis is based on typical complaints including abdominal pain, bloating, irregularities of bowel movements and defecation. The discussion of different etiopathogenetic models showed that irritable bowel syndrome is a biopsychosocial disorder in which psychosocial factors, altered motility and visceral hypersensitivity interact. When symptoms are moderate to severe and are associated with psychological distress and impaired quality of life, psychological treatments can be considered. Apart from symptomatic treatment with loperamide for diarrhoea and antidepressants for abdominal pain and comorbid psychological symptoms for example cognitive behavioral treatment, hypnotherapy, psychodynamic short-term psychotherapy and functional relaxation are being evaluated.     

Effects of Behavioral Group Therapy on chronic Pain

Abstract

Benign chronic pain is frequently reported among rehabilitation patients. The present study investigates a behavioral treatment model used with 3 consecutive groups of 8 chronic pain outpatients. The behavioral strategy used was to identify specific pain behaviors such as verbal expression of pain, consumption of analgesics and inactivity and to teach the patient to modify these patterns. The treatment was provided by a rehabilitation team and included contingency management of pain behaviors, applied relaxation and social skills training. Results showed significant 6 month follow-up reductions in the expression of pain, analgesics intake and level of rest for the group as a whole subsequent to intervention. In addition, two thirds of the group were engaged in formal pre-occupational training at follow-up.     

Effects of different psychological interventions on neck,shoulder and low back pain in female hospital staff

Abstract

One hundred and eleven females volunteered to take part in this intervention study of musculoskeletal pain. They all completed a survey of pain among five hundred and eighty-six female hospital staff and presented mild to severe pain in the neck, shoulder and/or low back. They were randomly assigned to one of the following groups; Focus on job-stress and psychosocial coping (Cognitive), relaxation training (Relaxation), the combination of the two (Combined) or to a control group (Control). Musculoskeletal pain (intensity and duration) was assessed by self-report prior to interventions, immediately after interventions, and at a four months follow-up. Results from multivariate analyses of variance as well as covariance (pre-intervention levels of pain as covariate) showed that magnitude of pain reduction was dependent upon the interaction between area of the back and type of intervention. These trends were more significant for intensity than for duration scores. They were due to reductions of pain in (1) neck and shoulders for the Cognitive and Combined groups and (2) in the low back and shoulders for the Relaxation group. The four month follow-up assessment revealed a significant risk of relapse only for duration of low back pain among subjects in the Combined group. Results from the Cognitive approach to intervention may reflect a causal role for ability to cope with psychosocial job stress in the development of neck and shoulder pain in female hospital staff.     

An evaluation of interdependent and independent group contingencies during the good behavior game

The Good Behavior Game (GBG) uses an interdependent group contingency to improve classroom behavior. Despite the wealth of research on the effectiveness of the GBG, some teachers may have concerns about their students’ abilities to work in teams, particularly if they have a history of poor social skills. We used an alternating treatments design to compare the relative effectiveness of the GBG with interdependent and independent group contingencies in a classroom for children with emotional and behavioral disorders. Our results showed that both versions of the GBG reduced verbal disruptions, inappropriate sitting, and off‐task behaviors for all children. However, the majority of children preferred the interdependent arrangement. We discuss how these results may promote more widespread use of the GBG with children with substantial behavioral challenges.