The effectiveness of Dry Bed Training for nocturnal enuresis in adults

Nine enuretic adults were successfully treated by the Dry Bed Training in a fairly short time (means = 15 weeks) including the retraining period for 3 Ss who relapsed after the therapy. There were no differences between primary and secondary (nocturnal) enuretics. The few relapses were neutralized by a short retraining. The study shows that this minimal intervention treatment is effective and efficient.     

Training the disturbed enuretic

Twenty-two disturbed enuretic children were treated for their bedwetting with training procedures. Eighteen of 22 (81.8%) reached the initial success criterion in an average of 57.5 days. Ten of the 18 (55.6%) met the retraining criteria of relapse, and 9 of the relapses were successfully retrained, while I stopped wetting spontaneously. As compared to non-relapsed children, relapsed children had a significantly higher number of initial symptoms checked. The results indicate that a training approach is effective for the treatment of enuresis in disturbed children, but the more disturbed have a greater likelihood of relapse.     

Conditioning two types of enuretics

Acquired enuretics (children who resume wetting after a period of dryness) have been distinguished from persistent enuretics (children who were never dry) in that the wetting of the former has been viewed as symptomatic of conflict and not modifiable by conditioning procedures. The present study compares these two types on measures of conditioning outcome and effectiveness, initial pathology and post-treatment adjustment.     

Dry-bed training: rapid elimination of childhood enuresis

Enuresis has been treated with moderate effectiveness by the urine-alarm method which requires many weeks of training. The present procedure used a urine-alarm apparatus but added such features as training in inhibiting urination, positive reinforcement for correct urinations, training in rapid awakening, increased fluid intake, increased social motivation to be nonenuretic, self-correction of accidents, and practice in toileting. After one all-night training session, the 24 enuretic children averaged only two bedwettings before achieving fourteen consecutive dry nights and had no major relapses. Little or no reduction in bedwetting occurred within the first two weeks for matched-control enuretics who were given the standard urine-alarm training. The results of a control-procedure showed that the new procedure did not involve Pavlovian conditioning. The new method appears to be a more rapid, effective and different type of treatment for enuresis.     

Persistence of response prevention effects following retraining of escape behavior

This study evaluated the effects of response prevention procedures on the extinction of escape behavior following the reinstatement of shock-escape training prior to the start of extinction. Female hooded rats were assigned to four groups (N = 10) in a factorial design which orthogonally combined response prevention or pseudo-prevention procedures with escape retraining or no retraining procedures. Results showed that prevention reliably impaired shock-escape behavior on early retraining trials; but this effect dissipated completely by the end of retraining. In extinction, prevention reliably facilitated the extinction of escape behavior relative to that of pseudo-prevention controls; but the degree of facilitation was reliably attenuated by retraining procedures. These findings were related to the competing response interpretation of prevention effects.     

PYRAMIDAL STAFF TRAINING IN THE EXTENSION OF TREATMENT FOR SEVERE BEHAVIOR DISORDERS

We implemented a pyramidal training procedure for staff working with individuals who exhibited self-injurious behavior (SIB), aggression, and disruption. Two adults with developmental disabilities and their direct-care staff and supervisors participated. Following successful treatment by the experimenters, two types of baselines were conducted with the clients and their direct-care staff. During an initial baseline, the staff implemented preexisting procedures. Staff members then received instruction on the new treatment procedures using training methods common throughout the institution, and data were collected during this “post-in-service” baseline. Experimenters then taught unit supervisors to implement treatment, collect and interpret data, and provide similar instructions and feedback to the staff members. The supervisor training was implemented in a multiple baseline design across subjects (clients and direct-care staff). Results showed little change following in-service training but noticeable improvements in direct-care staff behaviors and corresponding decreases in the clients' inappropriate behavior following the pyramidal training intervention with supervisors. Six additional clients (along with their direct-care staff and supervisors) participated in pre- and posttreatment replication designs, and their results provided additional support for the efficacy of the supervisor training procedures.     

Parent‐administered modified dry‐bed training for childhood nocturnal enuresis: evidence for superiority over urine‐alarm conditioning when delivery factors are controlled

We compared the relative efficacy of modified dry‐bed training and standard urine‐alarm conditioning for treating functional nocturnal enuresis in 36 children aged 7–12 years attending health centres in Glasgow, Scotland. A minimal intervention, self‐help approach was adopted. Parents and children received standardized instruction, which, for each method, consisted of one clinic interview and a manual and videotape for home viewing. Outcomes were contrasted with those from untreated controls. Twelve children were randomly assigned to each condition. All groups were matched for age, gender, social class (deprivation category), and baseline wetting frequency. In the two treated groups, an intake interview was followed by two review appointments, otherwise families carried out the programmes independently at home with fortnightly telephone support either until the success criterion of 14 consecutive dry nights was met or the 16 week maximum treatment period expired. Of the 12 children treated by dry‐bed training, eight achieved initial success compared with only three of the 12 treated by the conventional urine‐alarm method. One waiting‐list control child remitted spontaneously. ANOVA showed highly significant differences in wet nights per week immediately after intervention for both treatment and time factors (p < 0.001) and their interaction (p < 0.01). The dry‐bed group averaged 0.8 nights per week wet on treatment cessation, a frequency which was significantly superior to the average of 3.25 for the urine‐alarm group and 5.00 for the controls. Six months after attaining initial success, one child in each treated group had relapsed. Our results show an outcome of 58% long‐term remission (67% initial arrest, 13% relapse) for dry‐bed training when delivered by minimal intervention methods and indicate dry‐bed training as being more effective than orthodox urine‐alarm conditioning for the same input of clinic time and instruction. Copyright © 2002 John Wiley & Sons, Ltd.     

Drosophila Conditioned Courtship: Two Ways of Testing Memory

In Drosophila, courtship reduction in male flies that have previous experience of courting a mated female is a result of the counterconditioning of an attractive unconditioned stimulus (US)—the aphrodisiac—which becomes an aversive conditioned stimulus (CS) after being paired with an aversive US—the antiaphrodisiac. In a retention test with a virgin female lacking the antiaphrodisiac, males retain a lower level of courtship for 3 hr after training. However, a measure of courtship suppression, the learning index (LI), decreases significantly after only 1 hr. In contrast, in the retraining test with a mated female, the LI shows no decrease for 8 hr but falls below significance 16 hr after training. These results are discussed in terms of the transfer of training. Nonspecific transfer and nonassociative behavioral modifications play little, if any, role in the transfer of training. The retraining test is recommended as a new protocol for studying conditioned courtship. According to the model proposed here, in tests with a virgin female, the duration of memory retention is limited by the retention of the direct association between the CS and the aversive motivational system or by the retention of an internal representation of the US. In retraining tests, the CS–US association seems to be the only factor involved in transfer 3 or more hours after training.     

SUPPORTED EMPLOYMENT AS AN INTERVENTION PACKAGE: A PRELIMINARY ANALYSIS OF FUNCTIONAL VARIABLES

In this two-experiment investigation, the long-term (at least 6 months) employment of 51 moderately mentally retarded clients who were placed into 64 supported employment positions was first evaluated relative to 10 training and posttraining components that comprised a supported employment training package. In Experiment 1, chi-square analyses were used to identify three components that differentiated successful (employed for at least 6 months) from unsuccessful clients. In Experiment 2, 4 successful clients were further evaluated in a nonconcurrent multiple baseline design to determine whether the three variables identified during the group analysis (client advocate, collateral behavior, and follow-up plan) were included in the training packages. These results are discussed in terms of the need to establish better the functional variables of supported employment training programs.     

Cognitive-Behavioral Treatment of Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) can be treated effectively with cognitive-behavioral therapy. When working with clients who have GAD, therapy can focus on four central areas that help to promote therapeutic change. The initial focus of therapy is on developing a sound therapeutic alliance and educating the client about anxiety symptoms. Skills training focuses on relaxation training and cognitive changes that can help clients confront their worries in a constructive manner. Then, exposure to internal and external aspects of the anxiety can help clients test and refine their coping skills. Finally, because of the chronic nature of GAD, relapse prevention strategies can be used to help maintain treatment gains over time. These strategies allow a broad but flexible treatment plan that can be adapted to the unique needs of each individual client.     

Changes in meaning in life across the course of psychodynamic psychotherapy

Using the Meaning in Life Questionnaire (MLQ), we studied Presence and Search for meaning for 34 adult clients in psychodynamic psychotherapy. Clients completed the MLQ and Outcome Questionnaire (OQ) before intake and after every eight sessions. Variance in Presence scores was mostly attributable to clients; variance in Search scores was mostly attributable to clients and therapists. Clients initially high in Presence decreased and then increased back to initial levels; clients initially low in Presence increased and then decreased back to initial levels. Clients initially low in Search increased and then leveled off; clients initially high in Search decreased and then leveled off. In lagged cross panel analyses, when clients decreased in psychological distress during one eight-week time period, they increased in Presence during the next eight-week time period; when they increased in psychological distress during one eight-week time period, they increased in search in the next time period. Excerpts from post-therapy interviews illustrate the process of working with meaning in life in psychotherapy. Implications for practice and training are discussed.     

Development and convergent validation of a methodology for estimating cross-job retraining times

Cross-jobtransferability of skills is defined in terms of the ease with which individuals can apply knowledge and skills acquired in a previous job in learning to perform a new job. This study reports the development of a prototype methodology for estimating retraining times based on analyses of transferability of skills. Using this methodology which assesses interjob similarity in task content and task learning time, times to retrain across 41 different U.S. Air Force enlisted jobs were estimated. Convergent validities of retraining time estimates were tested in terms of correlations with differences in jobs': (a) general job learning difficulty, and (b) aptitude requirements. Results supported predictions that cross-job retraining time would be longer (a)into jobs that generally aremore difficult to learn, (b)from jobs that generally areless difficult to learn, and (c) across jobs having different, rather than similar, aptitude requirements. Implications for training, human resources planning, and coping with increasingly rapid technological changes in the workplace are discussed.Research sponsored by the Air Force Office of Scientific Research/AFSC, United States Air Force, under contract F49620-87-R-0004. The United States Government is authorized to reproduce and distribute reprints for governmental purposes notwithstanding any copyright notation hereon.     

Outcomes of systemic/strategic team consultation: I. Overview and one-month results

This is the first in a series of reports on an experimental, small-sample study of systemic/strategic team consultations. This report describes a "Milan-informed" method of team consultation for resolving therapy impasses. It then focuses on the initial one-month outcomes from the larger 3-year project. Eleven therapists were asked to select two ongoing cases matched for difficulty. While all cases continued in regular therapy, one of each therapist's cases was also selected at random to participate in a systemic/strategic, five-part team consultation. Analyses of one-month follow-up data showed that clients who participated in the team consultation were more likely to achieve their main and overall treatment goals than clients who received only regular therapy (p's less than .05, eta2 as a measure of effect size ranging from 32% to 41%). The strong findings of this initial study encourage more widespread use of team consultations as a context for treatment, training, and research.     

Gender-sensitive training for substance use disorder treatment: Results and implications of a pilot health professionals needs assessment

This study explored mental health practitioner training needs in gender-sensitive substance use disorder (SUD) counselling genderqueer populations. Informants were health professionals in SUD practices and from the Eastern Cape, South Africa (females = 75%; black = 90%, 10% = white, clinical and counselling psychologists = 10%, social workers = 65%, auxiliary health workers = 25%). They completed focus group interviews regarding their needs for gender-sensitive (GS) training in SUD treatment. Thematic analysis of the data indicated training needs in how to deal with their own bias and prejudice beliefs about the genderqueer population. Furthermore, results indicated that they needed training on how to manage the treatment setting once genderqueer clients were integrated in treatment with cisgender clients. Training for SUD treatment and care with genderqueer clients should prioritise gender sensitisation. Health professionals’ need gender equality awareness training for health care equity with the genderqueer community.     

Assisting At-Risk College Students With Attributional Retraining and Effective Teaching1

Attributional retraining appears to be an effective remedial intervention for college students. However, the potential moderating effects of student and classroom characteristics have not yet been investigated systematically. In two studies, attributional retraining was provided to low- and high-risk students, followed by a videotaped lecture presented by either an ineffective or effective instructor. Attributional retraining enhanced achievement on a lecture-based achievement test only when combined with effective teaching, improving the achievement of students who had previously performed poorly (Experiment l), and of low-achieving externals (Experiment 2). The intervention provided no advantage for previously successful students and low-achieving internals. Moreover, attributional retraining induced a more internal attribution profile in students with an external locus, and increased expectations of future success in both externals and internals, but again only when students also received effective instruction. These results suggest that contextual factors related to the classroom, such as quality of instruction, and individual differences have to be considered when developing attributional retraining programs.     

Personality Type Differentiation of Employed Versus Unemployed Clients

The 16 Personality Factors (16 PF) Test was used to determine if personality variables were significantly different for employed and unemployed clients. The results of the study indicate that demographic data failed to demonstrate any significant difference but that four factors on the 16 PF were found to be significant. Results should be of great interest to all professionals concerned with evaluation, adjustment, and/or placement of rehabilitation clients.     

Providing Guidance on the Health Effects of Religious/Spiritual Involvement: A National Assessment of University Counseling Professionals

This study assessed the perceptions and practices of a national sample of university counseling professionals (n = 306) regarding their provision of guidance on the health effects of religious/spiritual involvement. Relatively few (21%) discussed the physical health effects of religiosity/spirituality with their clients. The majority (52%) were unsure that such discussions would result in lower health risks; however, nearly half (48%) indicated that these would promote recovery. Almost two-thirds (64%) indicated that discussions of religious/spiritual involvement and health “should occur only with clients who indicate that religion/spirituality is important to them.” A plurality (36%) of the respondents had received no formal training on this topic. Implications for clinical training, university counseling centers, and future research are discussed.     

Learned suppression of photopositive tendencies in Drosophila melanogaster

A task was designed to teach individual flies to avoid a lighted area after they had displayed an initial preference for it. The flies walked in a T-maze and chose between a lighted and a darkened alley leading, respectively, to a lighted and a darkened vial. Flies that were photopositive on a first trial were subjected to an aversive stimulus (a filter paper inserted into the lighted vial and wetted with a quinine solution), and they performed 16 training trials; they learned to avoid the lighted vial. The flies trained with water instead of quinine in the lighted vial still display avoidance of the lighted vial, but to a lesser extent. The flies trained with a dry filter paper in the lighted vial did not show any increase in avoidance during training. Like the flies trained with no quinine at all, those trained to avoid the lighted vial under a partial reinforcement condition (one half of the trials with quinine, the other half with a dry vial) did not master the task. Finally, removal of the quinine after an avoidance acquisition criterion was reached resulted in an extinction process.     

A Common Elements Treatment Approach for Adult Mental Health Problems in Low- and Middle-Income Countries

This paper describes the Common Elements Treatment Approach (CETA) for adults presenting with mood or anxiety problems developed specifically for use with lay counselors in low- and middle-income countries (LMIC). Details of the intervention development, training, supervision, and decision-making process are presented. Case vignettes are used as examples throughout. Preliminary findings are presented on counselor/supervisor performance and client outcomes from practice cases completed prior to randomized controlled trials (RCT) conducted at two sites for adult survivors of torture and/or systematic violence in (a) southern Iraq and (b) Thailand-Burma border.Data suggest that local supervisors and lay counselors with little prior mental health training or experience maintained fidelity to the model. The majority of pilot clients were retained in treatment, suggesting acceptability. Using the Reliable Change Index (RCI) for each individual we examined the number of clients above a minimal threshold (z > 1.96) for each outcome. In Iraq 100% of clients had RCIs above the threshold for depression and posttraumatic stress, and 81.8% for impaired function. In Thailand, 81.3% of clients had RCIs above minimum threshold for depression, 68.8% for posttraumatic stress, and 37.5% for impaired function.Implementation of CETA is discussed in relation to cultural issues within LMIC. These findings, combined with US-based evidence, suggest that a common elements approach warrants further development and testing as a means for addressing the treatment gap for mental health problems in LMIC.     

Need for approval and counseling outcomes

The intent of this study was to determine the effects of a clients' need for approval on the outcomes of counseling. The expectation was that clients who have a high need for approval by others would cooperate more with the counseling process and would more often be successful in the sense of being rehabilitated. The Marlowe-Crowne Social Desirability Scale was administered to 167 applicants at a state rehabilitation agency immediately after the initial interview. It was hypothesized that successfully rehabilitated clients would obtain significantly higher social desirability scores than those clients who were not successful. The results confirmed the hypothesis at the .01 level of significance.