LEMON-JUICE THERAPY: THE CONTROL OF LIFE-THREATENING RUMINATION IN A SIX-MONTH-OLD INFANT1

Chronic, life-threatening rumination was eliminated in a six-month-old infant by squirting a small amount of lemon juice into her mouth whenever rumination or its precursors were detected. A brief suspension of this therapy demonstrated its crucial role. Lemon-juice therapy offers a practical and acceptable alternative to other therapies for rumination, namely electric shock and massive noncontingent attention. However, since this study is limited to a single case, claims as to the effectiveness of this therapy across children are premature.     

Assessment and treatment of rumination in a young man with autism

After a pretreatment screening analysis suggested that rumination by a 19‐year‐old man with autism was maintained by automatic reinforcement, we evaluated his preference for three snack foods and the frequency of his rumination after consuming each. Rumination was more common after eating high‐preference foods. We then examined noncontingent access to a type of lollipop (i.e., a Ring Pop?) to decrease rumination. The Ring Pop? reduced rumination to moderately low levels. Next, to further decrease rumination, we added a reprimand, which reduced rumination to near zero levels. Finally, we evaluated the reprimand by itself, which resulted in a reduction in rumination roughly equivalent to that produced by the Ring Pop?. Results are discussed in terms of the source of reinforcement for rumination and the behavioral mechanisms responsible for intervention effects.     

The combined effects of noncontingent reinforcement and punishment on the reduction of rumination

The current study extends the literature on the assessment and treatment of rumination through the evaluation of a combined reinforcement‐ and punishment‐based intervention. The study included a single participant with a history of rumination maintained by automatic reinforcement, as identified via a functional analysis. Both noncontingent reinforcement (NCR) with preferred edible items and punishment, in the form of a facial screen, were implemented separately to evaluate their independent effects on the occurrence of rumination. The final treatment package included both NCR and punishment procedures. Implementation of the combined treatment resulted in a 96.5% reduction in rumination relative to baseline. Procedural modifications and integrity errors also were evaluated.     

Brief functional analysis and supplemental feeding for postmeal rumination in children with developmental disabilities

Rumination is a serious problem demonstrated by some people with developmental disabilities, but previous research has not included a functional analysis and has rarely compared intervention methods during the assessment process. We conducted functional analyses with 2 children who displayed postmeal rumination and subsequently evaluated a supplemental feeding intervention following meals. Results showed that noncontingent food or liquid presentation effectively reduced rumination with both children.     

A comparison of noncontingent reinforcement,other competing stimulation,and liquid rescheduling for the treatment of rumination

Modified versions of three popular nonaversive treatments for rumination in a person with profound developmental delay were evaluated using an alternating treatments design (ATD) as a component of an ABAB design. Results showed that the most effective intervention involved noncontingent feeding every 20 s for the 30 min immediately following a meal. Further analysis demonstrated that no significant increase in rumination occurred during the 60 min after the treatment procedure had expired, thus indicating that rumination was not merely postponed. Results are discussed in terms of their relation to currently popular (satiation) interventions for the treatment of rumination in individuals with developmental disability. Future research needs are proposed from an analysis of known behavioral and physiological variables and their possible interactions. ©1997 by John Wiley & Sons, Ltd.     

Some effects of noncontingent positive reinforcement on multiply controlled problem behavior and compliance in a demand context

Functional analysis suggested that the problem behavior of an 8-year-old girl with autism was maintained by escape from demands and access to edible items. Noncontingent delivery of an edible item was sufficient to increase compliance and reduce the rate of problem behavior without the use of escape extinction in a demand context. Leaner and richer schedules of noncontingent reinforcement were equally effective, and there were minimal differences between noncontingent reinforcement and differential reinforcement of compliance.     

FUNCTIONAL ANALYSIS AND TREATMENT OF RUMINATION USING FIXED‐TIME DELIVERY OF A FLAVOR SPRAY

A functional analysis suggested that rumination exhibited by an adult with autism was maintained by automatic reinforcement. Next, a preference assessment with three flavor sprays (i.e., flavored sprays used by dieters) showed that apple pie spray was most preferred. Finally, the effects of fixed‐time delivery of the apple pie spray on levels of rumination were evaluated. The spray reduced rumination, and the participant was taught to self‐administer the spray.     

Enhancing the effects of extinction on attention-maintained behavior through noncontingent delivery of attention or stimuli identified via a competing stimulus assessment

Recent research has shown that the noncontingent delivery of competing stimuli can effectively reduce rates of destructive behavior maintained by social-positive reinforcement, even when the contingency for destructive behavior remains intact. It may be useful, therefore, to have a systematic means for predicting which reinforcers do and do not compete successfully with the reinforcer that is maintaining destructive behavior. In the present study, we conducted a brief competing stimulus assessment in which noncontingent access to a variety of tangible stimuli (one toy per trial) was superimposed on a fixed-ratio 1 schedule of attention for destructive behavior for individuals whose behavior was found to be reinforced by attention during a functional analysis. Tangible stimuli that resulted in the lowest rates of destructive behavior and highest percentages of engagement during the competing stimulus assessment were subsequently used in a noncontingent tangible items plus extinction treatment package and were compared to noncontingent attention plus extinction and extinction alone. Results indicated that both treatments resulted in greater reductions in the target behavior than did extinction alone and suggested that the competing stimulus assessment may be helpful in predicting stimuli that can enhance the effects of extinction when noncontingent attention is unavailable. DESCRIPTORS: Attention-maintained problem behavior, competing stimuli, extinction, functional analysis, noncontingent reinforcement     

Noncontingent reinforcement competes with response performance

Noncontingent reinforcement is a commonly used procedure to decrease levels of problem behavior. Goals of this intervention are to decrease motivation, responding, and the functional relation between behavior and consequences, but it could also possibly compete with performance of alternative desirable responses. In the current study, we assessed the effects of noncontingent reinforcement arranged from 0% to 100% of sessions on performance of alternative responding across two experiments. Experiment 1 assessed manding (i.e., requests) maintained by attention and tangibles with a child with developmental disabilities and Experiment 2 assessed keypecking maintained by food with six pigeons. We extended previous research by (a) showing that noncontingent reinforcement competes with both the acquisition and maintenance (performance) of an alternative response, (b) extending the generality of the findings across nonhuman and human participants, and (c) eliminating influence of sequence effects through random manipulations of noncontingent value in pigeons. Overall, greater amounts of noncontingent reinforcement competed with both acquisition and maintenance of alternative responding.     

Positive conditioned suppression: conditioned suppression using positive reinforcers as the unconditioned stimuli

Research has revealed the phenomenon of conditioned suppression in which the rate of responding is reduced during a stimulus that is paired with noncontingent shock. The present study replicated this procedure, but used noncontingent positive reinforcers instead of the aversive shock. The lever-pressing responses of rats were reinforced with food or water. While the rats were responding, a stimulus was occasionally presented and paired with the delivery of a noncontingent positive reinforcer, which was either food, water, or brain stimulation for different rats. The result was a reduction in the rate of responding during the conditioned stimulus. This finding shows that conditioned suppression occurs during a signal for reinforcing as well as aversive stimuli.     

A multi‐component approach to the treatment of chronic rumination

A multi‐component intervention was used to treat chronic rumination exhibited by an adult female diagnosed with a developmental disability. The intervention consisted of: (a) interruption of precursor behavior, (b) the alternation of 10‐min periods of continued instruction that involved walking and working with (c) 10‐min periods in which instructions were not delivered but a variable time 5‐s schedule of noncontingent attention was programmed, and (d) a 1‐min differential reinforcement of other behavior (DRO) schedule. During the intervention, rumination decreased by 82% relative to baseline. Next, components of the multi‐component intervention were systematically removed to evaluate their individual contribution. Results suggested that each individual component contributed to the overall treatment effects. Copyright © 2010 John Wiley & Sons, Ltd.     

THE USE OF A VERBAL REPRIMAND TO DECREASE RUMINATION IN A CHILD WITH AUTISM

After a pre‐treatment screening analysis suggested that rumination exhibited by a boy with autism occurred in the absence of social consequences, we evaluated the effect of a verbal reprimand contingent on the target behavior via a reversal design. The reprimand reduced rumination to near‐zero levels; we then thinned the reprimand schedule and rumination remained infrequent. Follow‐up data collected 6, 12, and 18 months after initial treatment suggested that intervention effects were maintained. Copyright © 2014 John Wiley & Sons, Ltd.     

Impact of rumination versus distraction on anxiety and maladaptive self-beliefs in socially anxious individuals

A large body of experimental evidence has demonstrated the adverse effects of rumination on depressive mood and cognitions. In contrast, while prominent models of social phobia (Clark & Wells, 1995; Rapee & Heimberg, 1997) have proposed rumination as a key maintaining factor, the effects of rumination in social anxiety have not been extensively explored. In a sample of (N = 93) undergraduates, this study investigated the impact of rumination versus distraction following a social-evaluative task on anxiety and another key component of social phobia: maladaptive self-beliefs. Relative to distraction, rumination maintained anxiety in both high and low socially anxious individuals, and maintained unconditional beliefs in high socially anxious individuals. The results support models of social phobia and also suggest important theoretical extensions. Implications for the treatment of social anxiety are discussed.     

NONCONTINGENT PRESENTATION OF ATTENTION AND ALTERNATIVE STIMULI IN THE TREATMENT OF ATTENTION-MAINTAINED DESTRUCTIVE BEHAVIOR

Previous research has demonstrated that destructive behavior may be reduced through noncontingent presentation of attention when attention is identified as the stimulus responsible for behavioral maintenance. Because it may not always be possible to deliver attention in all situations, we examined the extent to which alternative stimuli that have been identified through a choice assessment would substitute for attention (the functional analysis—based reinforcer) in a noncontingent reinforcement procedure. Prior to treatment, functional analyses demonstrated that the destructive behavior of 2 clients with mental retardation was maintained by adult attention. Next, a stimulus choice assessment identified highly preferred tangible items for the 2 clients. Finally, we compared the effectiveness of two noncontingent reinforcement procedures: continuous noncontingent access to attention and continuous noncontingent access to the tangible item identified in the choice assessment. For both clients, these noncontingent reinforcement procedures reduced destructive behavior. The results are discussed in terms of the clinical implications for the treatment of destructive behavior using functional and alternative stimuli.     

NONCONTINGENT DELIVERY OF ARBITRARY REINFORCERS AS TREATMENT FOR SELF-INJURIOUS BEHAVIOR

Results of recent research have shown that noncontingent reinforcement (NCR) can be effective in reducing the frequency of behavior problems. In typical NCR applications, the reinforcer that is responsible for behavioral maintenance (as demonstrated through a functional analysis) no longer follows occurrences of the target behavior but instead is delivered according to a time-based schedule. Thus, it is unclear if NCR would be effective if the target behavior continued to be reinforced or if arbitrary reinforcers (i.e., those irrelevant to behavioral maintenance) were substituted for the maintaining reinforcers in the NCR procedure. In this study, 2 individuals whose self-injurious behavior (SIB) was maintained by positive reinforcement were exposed to conditions in which arbitrary and maintaining reinforcers were withheld and were delivered either contingently or noncontingently. Results indicated that noncontingent delivery of arbitrary reinforcers was effective in reducing SIB even though occurrences of SIB produced access to the maintaining reinforcer. These results suggest that (a) arbitrary reinforcers may sometimes be substituted for maintaining reinforcers, (b) an important component of NCR procedures is alteration of a behavior's establishing operation, and (c) NCR with arbitrary reinforcers might therefore be effective when maintaining reinforcers cannot be identified or withheld during the course of treatment.     

NONCONTINGENT ESCAPE AS TREATMENT FOR SELF-INJURIOUS BEHAVIOR MAINTAINED BY NEGATIVE REINFORCEMENT

We extended research on the role of noncontingent positive reinforcement following a functional analysis of attention-maintained self-injurious behavior to self-injury maintained by negative reinforcement in 2 young males with developmental disabilities. During a pretreatment functional analysis, each participant's self-injury was shown to be differentially sensitive to escape from instructional activities as negative reinforcement. During noncontingent escape, escape from learning activities was provided on a fixed-time schedule that was not influenced by the participant's behavior. One participant was also exposed to differential negative reinforcement of other behavior. During this condition, escape from instructional activities was provided contingent on the omission of self-injury for prespecified intervals. Results showed that the provision of escape, even when noncontingent, resulted in significant reductions in self-injury. These results are particularly interesting in light of the experimental history of noncontingent reinforcement as a control rather than as a therapeutic procedure. Noncontingent escape is discussed as a form of extinction that may be less likely than other forms of extinction to produce severe side effects.     

Functional communication training and noncontingent reinforcement in treatment of stereotypy

A 6‐year‐old boy with autism spectrum disorder engaged in automatically maintained stereotypy in the form of opening and closing doors. A functional analysis confirmed that he also emitted problem behavior that was maintained by access to stereotypy. We evaluated the separate and combined effects of functional communication training and arbitrary noncontingent reinforcement on both response classes. Results showed that the combination of functional communication training and noncontingent reinforcement was more effective at reducing stereotypy than either intervention on its own, although effects on problem behavior were unclear. These results suggest that combinations of interventions may be useful in the treatment of automatically maintained problem behavior.     

Empirically derived consequences to treat rumination

We evaluated a contingent oral hygiene procedure on rumination emitted by a 9‐year‐old boy with autism. Results of a functional analysis screening suggested rumination was maintained by automatic reinforcement. We conducted a stimulus avoidance assessment to identify a hierarchy of potential consequences to be used in treatment. During treatment, contingent toothbrushing resulted in a 97% decrease in rumination. Finally, we transitioned to a less intrusive intervention (i.e., contingent mouthwash spray) and rumination remained at near‐zero levels. Treatment effects generalized to different settings and caregivers and maintained over a 4‐year period.     

Distinguishing rumination from worry in clinical insomnia

Research has found that repetitive thought processes, such as worry and rumination, play an important role in several disorders; however, these cognitive processes have not yet been examined in insomnia. This study explores rumination and worry in insomnia by examining: 1) whether those high and low on rumination and worry differ on subjective sleep measures, and 2) whether rumination and worry are distinct processes in insomnia. Participants (N = 242) were diagnosed with an insomnia disorder by sleep experts. Participants completed measures of worry and rumination and maintained a 2-week daily sleep log. Results of a multivariate analysis of variance found no main effect of worry; although high and low ruminators differed on several sleep log indices, including sleep efficiency, wakefulness after sleep onset and sleep quality. Factor analysis supported the idea that rumination and worry are separate constructs. Whereas previous research has focused on worry in insomnia, these findings suggest that rumination is important for understanding sleep disturbance. Further, although rumination and worry are both repetitive thought processes, these results indicate that they are distinct processes within insomnia and should be treated as such. The results are discussed with respect to treatment implications for Cognitive Behavioural Therapy for Insomnia.