Identifying predictive behavioral markers: A demonstration using automatically reinforced self‐injurious behavior

Predictive biomarkers (PBioMs) are objective biological measures that predict response to medical treatments for diseases. The current study translates methods used in the field of precision medicine to identify PBioMs to identify parallel predictive behavioral markers (PBMs), defined as objective behavioral measures that predict response to treatment. We demonstrate the utility of this approach by examining the accuracy of two PBMs for automatically reinforced self‐injurious behavior (ASIB). Results of the analysis indicated both functioned as good to excellent PBMs. We discuss the compatibility of this approach with applied behavior analysis, describe methods to identify additional PBMs, and posit that variables related to the mechanisms of problem behavior and putative mechanism of treatment action hold the most promise as potential PBMs. We discuss how this technology could guide individualized treatment selection, inform our understanding of problem behavior and mechanisms of treatment action, and help determine the conditional effectiveness of clinical procedures.     

Individual and combined effects of noncontingent reinforcement and response blocking on automatically reinforced problem behavior

Noncontingent reinforcement (NCR) and response blocking are 2 common interventions for problem behavior maintained by automatic reinforcement. We implemented NCR and blocking with 1 boy and found this combined intervention to be effective at decreasing high rates of automatically reinforced pica. With another child, we compared the effects of blocking alone to the combined intervention. With the third child, we compared NCR alone and blocking alone to the combined intervention. Results showed that the combined intervention was effective at reducing automatically reinforced problem behavior while moderate to high levels of item engagement maintained. When evaluated individually, neither NCR nor blocking was sufficient to reduce problem behavior to clinically significant levels.     

Distinguishing youths at risk for anxiety disorders from self‐reported BIS sensitivity and its psychophysiological concomitants

The aim of the study was to explore the psychophysiological concomitants of self‐reported behavioral inhibition system (BIS) sensitivity in adolescents (12 to 17 years old) supposed to be at risk for anxiety disorders. Twenty participants with high scores in self‐reported BIS sensitivity (at‐risk group) were matched in age and sex to 20 participants scoring in the normal range in BIS sensitivity (control group). Negative affect, negative emotion regulation style, and anxiety symptomatology were assessed by means of self‐reported measures. Cardiac and electrodermal response signals were recorded during baseline, paced breathing, exposure to an attentional task with response cost and fear‐relevant slides conditions. The at‐risk group exhibited higher scores on measures of negative affect, negative emotion regulation style, and anxiety symptomatology than their control counterparts. After controlling for negative styles of emotion regulation, groups did not differ in skin conductance reactivity during the attentional task with response cost, but participants at risk exhibited more nonspecific skin conductance responses than the control group during baseline recording. Regarding the cardiac concomitants, participants at risk presented lower vagal tone at resting conditions as compared to participants in the control group. Additionally, at‐risk participants exhibited lower flexibility across experimental conditions in heart rate and cardiac sample entropy measures than participants in the control group. These findings add knowledge on psychophysiological concomitants of BIS sensitivity and are discussed in light of associations between temperament and development of anxiety disorders in youth. They show how psychophysiological patterns observed in resting conditions could be useful endophenotypes to reliably detect individuals at risk before the disorder onset.     

Clinical research on behavioral activation as treatment for post‐traumatic stress disorder: A brief review and meta‐analysis

Behavioral activation (BA), an effective treatment for depression, has recently been receiving attention as a possible intervention for PTSD. BA interventions could be particularly useful in treating underserved populations (i.e., individuals with lower socioeconomic status). A literature search was conducted, which identified seven outcome studies that examined the effectiveness of stand‐alone BA treatment for individuals with PTSD. All studies identified for this brief review demonstrated clinically significant reductions in PTSD symptoms using BA as an intervention. A meta‐analysis of these few studies revealed a nonsignificant effect (Cohen's d = 0.713, p = .512) despite reporting an average symptom reduction of 25.8%. Other studies utilizing BA treatment for PTSD do so in tandem with other interventions and were excluded from analysis. This brief review summarizes the literature on the use of BA as a stand‐alone treatment for PTSD and suggests that future research seek to confirm the usefulness of BA as a potential treatment modality for mental health‐care providers treating individuals with PTSD.     

Application of a self‐management intervention to improve data recording of educational care providers

The present study evaluated the effects of a self‐management intervention on scheduled data recording by classroom instructors at a school for children with intellectual disability and neurodevelopmental disorders. In a multiple baseline design across two classrooms, the instructors recorded student data according to an established protocol at the school and based on earlier training they had received. During intervention, the instructors self‐monitored implementation of data recording procedures that were prompted by a signal from an automated count‐down timer. The self‐management intervention increased scheduled data recording by participants in both classrooms to 90–100%, and these results were maintained at 1‐ and 2‐month follow‐up assessments. These findings add to the small literature concerning self‐managed approaches to training and performance improvement, extend application within educational settings, and suggest practical advantages for supporting competencies of care providers.     

Functional analysis and treatment of inappropriate sexual behavior

The results of a functional analysis showed that inappropriate sexual behaviors exhibited by a 9-year-old boy who had been diagnosed with traumatic brain injury were maintained by positive reinforcement in the form of social attention. An intervention consisting of functional communication training and extinction resulted in reduced levels of inappropriate sexual behaviors.     

Response competition and stimulus preference in the treatment of automatically reinforced behavior: a comparison

Clinicians are particularly challenged by the development of interventions for behavior maintained by automatic reinforcement because reinforcers that maintain the responses often cannot be directly observed or manipulated. Researchers have conducted either preference assessments or competing items assessments when developing effective treatments for behavior maintained by automatic reinforcement. However, interventions based on these assessments have not been directly compared. The current study evaluated procedures to make such a comparison. High-competition items resulted in greater reductions in vocal stereotypy than did high-preference items for a preschool boy with autism.     

A comparison of rate‐based and latency‐based assessments for determining demand aversiveness

Demand assessments are used to determine the relative aversiveness of demands. This study compared two demand assessments (i.e., rate‐based and latency‐based) proposed in past research with three children with intellectual and developmental disabilities. We compared the hierarchical outcomes of demand aversiveness and efficiency of the two assessments. Differing degrees of correspondence between the assessments was found across participants. The latency‐based measure was most efficient for a participant with high‐rates of problem behavior. The rate‐based assessment was more efficient for a participant with low‐rates of problem behavior. More research is needed to determine when the different assessments should be conducted.     

Political ideology,helping mechanisms and empowerment of mental health self‐help/mutual aid groups

Self‐help/mutual aid groups share common attributes such as they are peer‐led, address a common problem or condition, have a voluntary character and little or no connection with professionals. However, these groups may vary according to their political ideology and focus on personal or/and societal change. This study examines the role of political ideology of self‐help/mutual aid groups and differences in psychosocial characteristics of group members. Fourteen mental health self‐help/mutual aid groups in England were studied. On the basis of stated aims and principles and following semi‐structured interviews with group leaders (facilitators/chairpersons), these were classified according to Emerick's typology as conservative (eight groups), combined (three groups), and radical (three groups). Group members (n = 67) completed questionnaires to assess personal empowerment, mental wellbeing, social networks and support, group identification and helping processes in the groups. Findings suggested that all self‐help group members experienced a large number of naturally occurring helping process and felt empowered whilst they shared limited social networks and support and marginal mental wellbeing. Different ideological types of self‐help groups may be related to specific helping processes and particular aspects of personal empowerment. Specifically, members of conservative and combined groups reported more expressive group processes like sharing of feelings and self‐disclosure, while radical group members reported more optimism/control over their lives. Furthermore, group identification was associated with specific helping processes and aspects of personal empowerment in the three group categories. Copyright © 2002 John Wiley & Sons, Ltd.     

Conceptualizing Nonsuicidal Self‐Injury as a Process Addiction: Review of Research and Implications for Counselor Training and Practice

Nonsuicidal self‐injury (NSSI) may be characterized as a process addiction for some individuals who self‐injure. The authors review findings on the addictive features of NSSI, including compulsivity, loss of control, continued use despite negative consequences, and tolerance.     

Post‐traumatic functional recovery and reorganization in animal models: A theoretical and methodological challenge

Studies addressing cerebral functional localization face methodological and theoretical problems. Lesion experiments expect that when a functionally specialized structure is missing, its function can be deduced from the resulting impairments. Mostly, however, initial impairments are partially or fully eliminated through functional recovery. Apparently, such a recovery contradicts the notion of functional localization. In order to understand the mechanisms of recovery, improved methodology and a new theoretical framework are required. Insights into the mechanisms of recovery can be achieved by using “challenge” techniques, where functionally recovered individuals are exposed to organic and behavioral challenges, e.g. pharmacological manipulations or additional lesions, as well as modified test situations. Using such methods, a number of principles of functional recovery have emerged. We evaluate some of the available theories of post‐traumatic recovery against these principles and find that none of them can account for the principles. Finally, we present a new conceptual framework – the Reorganization of Elementary Functions (REF) model. This model reconceptualizes the term “function”, suggests mechanisms of post‐traumatic reorganizations, and resolves the contradiction between localization and functional recovery.     

Linking family incivility to workplace incivility: Mediating role of negative emotions and moderating role of self‐efficacy for emotional regulation

The research on work‐related antecedents of workplace incivility (WI) is well‐established, yet relatively less attention has been paid to non‐work‐related experiences as key antecedents to employees’ incivility at work. Drawing upon the incivility spiraling framework and spillover theory, we use a moderated‐mediation model to investigate the impact of employees’ experience of family incivility on their behavioral WI through the mediation of negative emotions and the moderation of self‐efficacy for emotional regulation (SEER). The multisource field data also demonstrate general support for the hypothesized relationships. Findings revealed that negative emotions carry the spiraling effect from family incivility to WI. In addition, SEER moderated the positive direct relationship of experienced family incivility and negative emotions, and indirect association with behavioral WI. These findings have implications for theory and management alike, further suggesting directions for future research.     

An Analogue Study of the Psychological and Psychosocial Processes Associated With Post‐concussion Symptoms

This study used an analogue design to investigate post‐concussion syndrome and the psychological and psychosocial processes associated with post‐concussion symptom (PCSx) reporting. The study examined the role of expectation in reporting of PCSx, the nature of associated psychological and psychosocial difficulties, and the “good‐old‐days” phenomenon. Forty‐five healthy participants were randomly assigned to one of two groups: (1) a control group or (2) an expectation group who were asked to perform as if they had experienced a mild traumatic brain injury. Fourteen psychiatric patients comprised the clinical group. Self‐report questionnaires assessing PCSx and psychological and psychosocial variables were administered. It was hypothesised that PCSx would be non‐specific, that the expectation group would report greater dysfunction than controls, and that the “good‐old‐days” phenomenon would cause the expectation and clinical groups to underestimate pre‐morbid PCSx. All participants reported some degree of dysfunction, and the expectation and clinical groups underestimated past PCSx. The expectation group reported more PCSx and psychological and psychosocial dysfunction than controls, resembling the clinical group. The results demonstrate that expectation can cause otherwise healthy individuals to resemble a clinical group in terms of their level of endorsement of psychological and psychosocial dysfunction.     

Functional analysis and treatment of the delusional statements of a man with multiple disabilities: a four-year follow-up

Although delusional statements in people with intellectual disabilities and traumatic brain injury can be treated using behavioral interventions, none have demonstrated long‐term treatment effects. In the current study, a functional analysis demonstrated that delusional statements were maintained by attention. Differential reinforcement of alternative behavior and extinction of delusional statements resulted in near elimination of delusional statements and an increase in nondelusional statements. Follow‐up at 6 months, 1, 2, and 4 years indicated that treatment gains were maintained with continued staff training.