False-positive maintenance of self-injurious behavior by access to tangible reinforcers.

Results of a functional analysis indicated that the hand mouthing of a woman with developmental disabilities was maintained by multiple sources of control (sensory stimulation and access to a leisure item). Further assessment revealed that access to several other items also produced high rates of hand mouthing. However, direct observation conducted in the woman's home indicated that none of these items was delivered contingent upon hand mouthing. When the consequence observed most frequently in the home was incorporated into the functional analysis, rates of hand mouthing were no higher than they were during an alone condition. We concluded that hand mouthing, although maintained by automatic reinforcement, was also susceptible to social contingencies when exposed to them during assessment, thereby producing a partially false-positive outcome.     

The impact of functional analysis methodology on treatment choice for self-injurious and aggressive behavior.

Self-injurious behavior (SIB) and aggression have been the concern of researchers because of the serious impact these behaviors have on individuals' lives. Despite the plethora of research on the treatment of SIB and aggressive behavior, the reported findings have been inconsistent regarding the effectiveness of reinforcement-based versus punishment-based procedures. We conducted a literature review to determine whether a trend could be detected in researchers' selection of reinforcement-based procedures versus punishment-based procedures, particularly since the introduction of functional analysis to behavioral assessment. The data are consistent with predictions made in the past regarding the potential impact of functional analysis methodology. Specifically, the findings indicate that, once maintaining variables for problem behavior are identified, experimenters tend to choose reinforcement-based procedures rather than punishment-based procedures as treatment for both SIB and aggressive behavior. Results indicated an increased interest in studies on the treatment of SIB and aggressive behavior, particularly since 1988.     

Side effects of extinction: prevalence of bursting and aggression during the treatment of self-injurious behavior

Findings from basic and applied research suggest that treatment with operant extinction may produce adverse side effects; two of these commonly noted are an increase in the frequency of the target response (extinction burst) and an increase in aggression (extinction-induced aggression). Although extinction is often used to treat problem behavior in clinical settings, few applied studies have examined the prevalence of these side effects or their possible attenuation with other operant procedures. An analysis of 41 data sets for individuals who received treatment for self-injurious behavior indicated that extinction bursts or increases in aggression occurred in nearly one half of the cases. The prevalence of bursting and aggression was substantially lower when extinction was implemented as part of a treatment package rather than as the sole intervention.     

A Guide to Women in Management

The majority of occupational therapists are female clinicians who tend to be motivated by human service. They do not tend to be motivated by administrative or managerial responsibilities beyond those essential to local disciplines functions. More occupational therapists may become interested in management once they are aware of sociocultural assumptions and prejudices as well as the specific qualifications and competencies involved. Sex role stereotyping and some roles are reviewed. Assertiveness training and basic management competencies are listed as pertinent skill acquisitions.     

On the relation between object manipulation and stereotypic self-injurious behavior

Results from a number of studies have shown an inverse relationship between stereotypic behavior and object manipulation. The purposes of this study were to determine whether techniques similar to those used previously (prompting and reinforcement) would be effective in increasing object manipulation under both prompted and unprompted conditions, and to ascertain whether increases in object manipulation would result in decreases in stereotypic self-injurious behavior (SIB). Two individuals with developmental disabilities who engaged in SIB maintained by automatic reinforcement participated. Results showed that object manipulation increased from baseline levels when experimenters prompted participants to manipulate leisure items, but that object manipulation was not maintained under unprompted conditions, and rates of SIB stayed within baseline levels. We then attempted to increase object manipulation further by (a) reinforcing object manipulation, (b) blocking SIB while reinforcing manipulation, and (c) preventing SIB by applying protective equipment while reinforcing object manipulation. Reinforcing object manipulation alone did not affect levels of object manipulation. Blocking effectively reduced attempts to engage in SIB for 1 participant but produced no increase in object manipulation. When the 2nd participant was prevented from engaging in SIB through the use of protective equipment, rates of object manipulation increased dramatically but were not maintained when the equipment was removed. These results suggest that stimulation derived from object manipulation, even when supplemented with arbitrary reinforcement, may not compete with stimulation produced by stereotypic SIB; therefore, direct interventions to reduce SIB are required.     

The use of brief restraint plus reinforcement to treat self-injurious behavior

This study evaluated the use of brief arm restraint plus differential reinforcement of alternative behavior to treat the self-injurious behavior of two residents with multiple handicaps and profound mental retardation. The study took place in a nursing home and sessions were conducted for 15 minutes, Monday through Friday. The design contained both multiple baseline and reversal components. Mean levels of self-injurious behavior and stripping for one client were reduced from 92 to 16% and 81 to 2%, respectively, by the treatment. Her appropriate behavior increased from a mean of 18% in baseline to 100% in treatment. The second client's self-injurious behavior averaged 39% in baseline, but was reduced to a mean of 9% in treatment. His throwing decreased from a mean of 54% prior to treatment to a mean of 2%, while appropriate object manipulation increased from 26 to 99%. These data support the use of brief restraint plus reinforcement for decelerating severe self-injurious behaviors and accelerating appropriate behaviors in adults with profound mental retardation. The advantages of this treatment are that it appears to be less intrusive and to offer more educational benefits than other commonly used techniques.     

Comparison of non-suicidal self-injurious behavior and suicide attempts in patients admitted to a psychiatric crisis unit

The aim of the current study was to examine differences in personality, coping skills, and select psychopathology symptoms in psychiatric patients with and without non-suicidal self-injury and/or suicide attempts. We collected data in a sample of 128 psychiatric patients by means of self-report questionnaires measuring self-harm, psychological symptoms, personality and coping skills. Results support a continuum of self-harm such that patients with both non-suicidal self-injury and suicide attempts exhibit significantly greater levels of psychopathology and lower levels of adaptive personality traits and coping skills. The findings point to the clinical importance of making a distinction between non-suicidal self-injury and suicide attempts, and offers additional variables to consider outside of intent when appraising suicide risk.     

Early maladaptive schemas and non-suicidal self-injury among young adults: A preliminary investigation

Non-suicidal self-injury (NSSI) represents a critical mental health issue among young adults. Accordingly, it is important to understand potentially modifiable processes involved in its enactment. The current investigation built on previous work to better understand the nature of early maladaptive schemas (EMS) in the context of NSSI. One hundred and thirty young adults completed questionnaires assessing NSSI history, EMS and depressive symptoms. Results indicate that EMS may play a role in NSSI engagement after controlling for depressive symptoms. Specifically, higher scores on social isolation and emotional inhibition and possibly lower scores on entitlement/grandiosity schemas may differentiate those who self-injure from those who do not. Furthermore, higher levels of dependence/incompetence schema may differentiate those who report a higher NSSI frequency and those who report a less frequent NSSI history. Although a nascent area of study, our findings suggest that it may be fruitful to consider conceptualizing NSSI within a schema therapy framework.     

Functional analysis of self-injurious behavior and its relation to self-restraint

Some individuals who engage in self-injurious behavior (SIB) also exhibit self-restraint. In the present study, a series of three functional analyses were conducted to determine the variables that maintained a participant's SIB, one without restraint items available, one with a preferred and effective form of self-restraint (an airplane pillow) available noncontingently, and one with this item delivered contingent on SIB. Results suggested that SIB was reinforced by escape and by access to self-restraint materials, self-restraint appeared to be maintained by automatic reinforcement, and continuous access to highly preferred restraint materials effectively suppressed SIB.     

Rapid assessment of the effects of restraint on self-injury and adaptive behavior

We evaluated the effects of restraint on occurrences of self-injurious behavior (SIB) and adaptive responses exhibited by 2 individuals across eight response-effort conditions: baseline (no restraints); restraint sleeves without stays; restraints with 5, 10, 15, 20, or 25 thin metal stays; and restraints with five thick metal stays. From this analysis, we identified a restraint level for each participant that reduced SIB but did not inhibit adaptive responding.     

青少年自伤行为的机制及影响因素:基于情绪管理的视角

青少年是自伤的高危人群,这与自伤的情绪管理功能密切相关。基于情绪管理视角,生物社会模型、回避体验模型和情绪管理模型分别从不同侧面揭示了情绪管理在自伤发生中的核心地位。综合目前关于自伤的心理学及跨学科研究成果发现,青少年自伤的影响因素主要包括基因与脑等生物学因素、家庭与学校环境中的人际因素,以及个体的人格特征。其中,基因、脑与家庭环境对青少年自伤的影响尤为关键。今后应在纵向研究、基因与环境交互作用以及脑成像技术融合等方面对自伤进行进一步探讨。     

The effects of noncontingent access to single- versus multiple-stimulus sets on self-injurious behavior

The automatically reinforced self-injury of a girl with autism was treated by providing noncontingent access to a single set of preferred toys during 30-min sessions. The reductive effects of the intervention waned as the session progressed. Rotating toy sets after 10 min or providing access to multiple toy sets resulted in reductions that lasted the entire 30 min.     

Dialectical thinking and health behaviors: The effects of theory of planned behavior

The primary purpose of this study was to investigate whether the theory of planned behavior (TPB) mediated the relationship between dialectical thinking and health behaviors. A sample of 285 undergraduates was tested with a dialectical thinking styles scale, health promoting lifestyle profiles, and TPB questionnaires. Structural equation modeling was used for data analysis. Results indicated that all the three dimensions of thinking styles (belief in the connection, acceptance of change, and acceptance of contradiction) exerted significant effects on TPB constructs. Specifically, the connection and the change dimensions had positive effects on health behaviors mediated by TPB, whereas the contradiction dimension had a negative effect. Model 2 showed a satisfactory fit, demonstrating the influential pathways between dialectical thinking and health behaviors. Implications in issues of health promotion and future research are discussed.     

Using the Linehan Risk Assessment and Management Protocol With a Chronically Suicidal Patient: A Case Report

The Linehan Risk Assessment and Management Protocol (LRAMP) is an empirically supported, comprehensive framework used to assess suicide risk and protective factors, and provide a guide for the therapist to consider reasonable options for intervening on suicidal behavior. This protocol includes a structured checklist for assessing, managing, and documenting suicide risk. It also structures the documentation to clearly describe the presentation, assessment, in-session interventions, decision-making process, and follow-up to other members of the treatment team. This paper describes a case in which the LRAMP was used to guide the assessment, intervention, and documentation of the suicidal behavior of a patient, “Ann,” being treated with outpatient Dialectical Behavioral Therapy in a community mental health clinic. Each section of the LRAMP is discussed as it was used with this complex patient, who had history of high utilization of acute psychiatric services. Application of the LRAMP included the assessment of risk and protective factors, and the use of an individualized crisis plan that engaged the patient, her family, the therapist, and the clinical team, to decrease acute risk, continue outpatient treatment, and avoid inpatient hospitalization. The considerations for documenting clinical decision-making with chronically suicidal patients are discussed.     

青少年个性特征、最要好同伴吸烟行为与青少年吸烟行为的关系

本研究旨在探讨最要好同伴吸烟、青少年个性特征与青少年吸烟行为的关系.对北京市一所普通中学和一所重点中学的1042名初一至高三学生进行问卷调查,让被试自我报告他们和最要好同伴的吸烟行为,以及他们的个性特点.结果表明:(1)吸烟和不吸烟的青少年在遵从动机、自我效能感上存在着显著的差异.与不吸烟青少年相比,吸烟的青少年表现出更高的遵从动机和更低的自我效能感;(2)青少年的遵从动机、自我效能感与最要好同伴吸烟行为间存在显著关系.遵从动机高、自我效能感低的青少年,其最要好同伴吸烟率要显著地高于遵从动机低、自我效能感高的青少年;(3)最要好同伴吸烟行为与青少年吸烟行为间存在极其显著的相关;(4)最要好同伴吸烟行为既对青少年吸烟行为产生直接作用,又通过自我效能感、遵从动机对青少年吸烟行为产生间接影响.但最要好同伴吸烟行为对青少年吸烟行为的直接作用要大于间接作用.     

自我批评与青少年自伤:有调节的中介效应

采用情绪调节量表、自我批评量表、心理痛苦量表和自伤行为量表对914名中学生进行测查,从中筛选出311名有自伤行为的青少年进行统计分析,探讨自我批评与青少年自伤行为的关系,并在此基础上提出一个有调节的中介模型,考察心理痛苦的中介作用和认知重评的调节作用。结果表明:(1)在控制了性别和是否独生子女的影响后,自我批评可以显著正向预测青少年的自伤行为,心理痛苦在二者之间起中介作用;(2)自我批评通过心理痛苦对自伤行为的间接效应受到认知重评的调节,认知重评可以减弱自我批评对自伤行为的间接影响。     

Stopping the Nonadherence Cycle: The Clinical and Theoretical Basis for Dialectical Behavior Therapy Adapted for Adolescents With Chronic Medical Illness (DBT-CMI)

Most adolescents with chronic illness do not adhere to their regimen. A novel transdiagnostic adaptation of dialectical behavior therapy (dialectical behavior therapy for chronic medical conditions; DBT-CMI) is presented to improve medical adherence in adolescents. The authors describe the approach of DBT-CMI and the model’s conceptualization of nonadherence, with specific focus on the core concepts of non-adherence across illness in adolescence.DBT-CMI has been piloted in two disease groups with preliminary benefit. DBT-CMI lends itself theoretically as a transdiagnostic approach due to specific skills that target core concepts of nonadherence in adolescence. Future research is warranted on the applicability of DBT-CMI across other pediatric medical conditions to replicate findings and examine long-term outcomes.     

Decreasing problem behavior associated with a walking program for an individual with developmental and physical disabilities

In the current investigation, a functional analysis suggested that positive reinforcement in the form of physical contact maintained the self-injurious behavior of a girl with developmental and physical disabilities. We used the information obtained from the functional analysis to develop a treatment for noncompliance with walking in which a therapist removed physical interaction following inappropriate behavior during walks.     

The role of emotion reactivity and gender in the relationship between psychopathology and self-injurious behavior

The goal of the present study was to examine emotion reactivity, a broad construct that consists of an individual’s sensitivity, intensity, and persistence of emotional reactions, as a mediator of the relationship between two types of psychopathology (depression symptoms and borderline personality disorder (BPD) symptoms) and history of self-injurious behavior (non-suicidal self-injury (NSSI) and suicide attempts (SA)). We also examined gender as a potential moderator of this relationship. Participants (N = 1914) completed measures of emotion reactivity, psychopathology, and self-injurious behavior. Results using a series of mediated path analyses indicated that emotion reactivity mediated the relationship between (1) depressive symptoms and NSSI in females only, (2) depressive symptoms and SA in females only, and (3) probable BPD diagnosis and NSSI in both genders. Emotion reactivity did not mediate the relationship between probable BPD diagnosis and SA in either gender. Our findings suggest that emotion reactivity is a possible pathway through which depression and self-injurious behavior relate, especially in women. We temper these findings, however, within the context of relatively modest observed effects.     

Dialectical Behavior Therapy With Prolonged Exposure for Adolescents: Rationale and Review of the Research

Among adolescents, interpersonal trauma has been associated with severe post-traumatic stress disorder (PTSD) and impairments across multiple domains of functioning (e.g., Derosa, Amaya-Jackson & Layne, 2013; Ford, Courtois, Steele, van der Hart, & Nijenhuis, 2005; van der Kolk, 2005). Such difficulties can include high-risk behaviors such as active suicidality (Middlebrooks & Audage, 2008) and nonsuicidal self-injurious behavior (NSSI; Hu, Taylor, Li, & Glauert, 2017). While there have been many advances in the treatment of trauma, treatment dropout for adolescents seeking trauma-informed treatment is predicted by diagnostic comorbidity and complexity (Sprang et al., 2013), as well as the number of traumatic events endorsed (Wamser-Nanney & Steinzor, 2016). Many traumatized adolescents with high-risk behaviors are referred to Dialectical Behavior Therapy (DBT-A). However, DBT-A does not yet include a specific, evidence-based protocol for treating PTSD, without which treatment gains may not be sustained for traumatized adolescents (Harned, Korslund, & Linehan, 2014). While Prolonged Exposure (PE) is indicated as the gold-standard treatment for PTSD and has proven effective for adolescents (PE-A; Foa, McLean, Capaldi, & Rosenfield, 2013), it has not yet been validated with adolescents who are actively suicidal. However, PE has successfully been integrated within DBT for adults with co-occurring Borderline Personality Disorder and PTSD (e.g., DBT-PE; Harned et al., 2014). Based upon this model, the current paper proposes the integration of DBT-A and PE-A to treat adolescents with interpersonal trauma who also present with high-risk behaviors. The paper discusses anticipated complications related to adapting this model for adolescents and provides direction for future research.