USE OF NEGATIVE REINFORCEMENT IN THE TREATMENT OF SELF-INJURIOUS BEHAVIOR

Behavioral assessment procedures were used to determine the maintaining conditions of self-injury exhibited by 2 children with severe multiple handicaps. For both children, negative reinforcement (escape from grooming activities) was determined to be the maintaining reinforcer for self-injury (hand/arm biting) within an alternating treatments design. The treatment packages involved the use of negative reinforcement (brief escape from grooming activities) contingent upon a behavior that was incompatible with self-injury (reaching and pressing a microswitch that activated a prerecorded message of “stop”). Treatment was evaluated with a reversal design for 1 child and with a multiple baseline across grooming activities for the 2nd child. The treatment led to a marked decrease in self-injury for both children. At follow-up, high rates of self-injury were reported for the 1st child, but low rates of self-injury and an increase in task-related appropriate behavior were observed for the 2nd child.     

Case study: Effects of naltrexone and sibis on self-injury

The present case study was an effort to determine the relative effectiveness of two variant treatment modalities, and to provide an exploratory study of the hypothesis that therapy with naltrexone might increase the effectiveness of an aversive stimulus in controlling self-injury. Data are presented for a man who was treated for severe self-injury with the Self-Injurious Behavior Inhibiting System (SIBIS) and naltrexone, conducted under open-trial conditions utilizing fixed doses of 50 mg, 75 mg, and 100 mg per day. The effects of naltrexone on SIB were evaluated alone and paired with SIBIS. When used alone, lower dosages of naltrexone produced moderate decrements in self-injury. However, the rate of SIB increased in a dose-dependent manner when naltrexone was paired with SIBIS. The data also suggested that naltrexone may have caused a generalized blunting of both positive and negative affect.     

大学生自伤行为的强化敏感性基础

强化敏感性包括惩罚敏感性和奖励敏感性, 它影响个体的情绪、动机和行为过程, 与个体的情绪反应性密切相关。极端的强化敏感性与情绪管理障碍及多种自伤相关行为存在密切联系。为探索强化敏感性与自伤行为的关系, 研究1采用BIS/BAS量表和青少年自我伤害问卷, 对717名大学生进行了调查。研究2在研究1的基础上, 采用Q−任务和CARROT范式, 由127名大学生参加实验, 进一步考察不同功能的自伤行为的强化敏感性基础。结果表明：①惩罚敏感性、奖励敏感性及其愉悦寻求维度均对自伤行为有正向预测作用; ②情绪管理组自伤被试以高惩罚敏感性和接近正常的奖励敏感性为特征, 刺激寻求组自伤被试以高奖励敏感性和接近正常的惩罚敏感性为特征。结论：强化敏感性可有效预测自伤行为; 情绪管理和刺激寻求两种功能的自伤行为具有不同的强化敏感性基础; 对自伤行为进行分类研究十分必要。     

A Daily Diary Investigation of the Defective Self Model Among College Students With Recent Self-Injury

The Defective Self Model of self-injury (Hooley, Ho, Slater, & Lockshin, 2010) asserts that individuals choose to self-injure to gratify the desire for self-punishment associated with a self-critical cognitive style. Specifically, self-injury is used to regulate negative self-directed thoughts and emotions and is made accessible via the belief that the individual deserves punishment. This study sought to test primary assumptions of the Defective Self Model using a 2-week daily diary protocol. It was hypothesized that trait self-criticism would predict daily self-injury urge intensity and behaviors directly, as well as indirectly, through daily thoughts about deserving punishment. We also posited that guilt would predict self-injury urge intensity and behaviors beyond sadness, hostility, and fear. Support for primary hypotheses was mixed. Self-criticism did not directly predict self-injury outcomes, but did indirectly predict urge intensity through daily thoughts about punishment. Daily guilt predicted self-injury urge intensity beyond daily sadness, hostility and fear and was the only type of negative affect associated with self-injury behavior. Results are primarily contextualized through a social cognitive lens in which self-injury urge is precipitated by the activation of a self-critical schema in daily life. Alternatively, self-criticism may serve as a gateway to initial self-injury but lack the sensitivity to predict individual self-injury episodes. Treatments designed to reduce self-critical thoughts and bolster self-compassion may decrease self-injury urge intensity, thereby affecting the frequency of self-injury episodes.     

社会排斥对青少年自伤的影响:羞耻感的中介和认知重评的调节

通过3个行为实验考察了社会排斥对青少年自伤的影响。实验1发现,社会排斥和自伤经历能明显增加青少年的自伤时长(假设1);实验2进一步验证假设1,并验证了羞耻感的中介作用(假设2);实验3验证了认知重评对羞耻感中介效应的调节作用(假设3)。结果表明,社会排斥通过诱发羞耻感影响青少年自伤,但采用认知重评的情绪管理策略能够有效阻断羞耻感的中介作用。本研究为青少年自伤的认知干预提供了有力的实证支持。     

Ecological Variation in Self-Injury Behavior

ABSTRACT: Only recently have efforts been made to discover the extent of self-injury behavior in the general population. The study reported here was designed to ascertain and examine the degree of relationship between the ecological distribution of self-injury behavior and the indices of economic and ethnic status. The general hypothesis predicts that high rates of self-injury behavior are associated with low economic status and high ethnic status census tract populations in a northern metropolitan area. A total of 2,755 cases of self-injury were collected for the year 1972 from the records of the city and county police departments, hospital emergency facilities, and a sample of private physicians. Self-injury behavior was defined as any case of self-inflicted overdosage, asphyxiation, or injury, whether or not there was evidence of suicidal intent. The indices of economic and ethnic status for the various census tracts were computed in the manner suggested by Shevky and Bell (1955) . All the measures of economic status were found significantly related to self-injury in the predicted direction. The relationship between ethnic status and self-injury rates was not significant. When ethnic status was disaggregated, a significant relationship was found between self-injury rates for nonwhites and foreign-born whites. The explanation was offered that ethnic differences in self-injury are mediated by economic status variables and subcultural factors.     

THE USE OF PHYSICAL RESTRAINT IN THE TREATMENT OF SELF-INJURY AND AS POSITIVE REINFORCEMENT

Two experiments investigated the effects of a treatment package on the self-injurious behavior of three profoundly retarded persons who appeared to enjoy the physical restraints used to prevent their self-injury. The treatment package included physically restraining subjects contingent on increasing periods of time during which no self-injury occurred, and providing them with toys and attention during intervals between restraints. A reversal and multiple-baseline analysis documented that the rapid and complete reduction in self-injury by all subjects was due to this treatment package. Because these results suggested that physical restraint might function as a positive reinforcer, in a third experiment physical restraint was applied contingent on a marble placement response with one subject. A reversal design demonstrated that toy play systematically increased when each response resulted in restraint. The experiments have implications for the nonaversive remediation of self-injury in individuals who are restrained, as well as for the development and maintenance of self-injury in natural settings.     

青少年抑郁与自伤关系的追踪研究：亲子沟通的调节作用

为考察青少年抑郁与自伤的双向关系及亲子沟通的调节效应,采用青少年自我伤害问卷、流动中心用抑郁量表和亲子沟通量表对595名初一学生进行为期10个月的追踪研究。结果发现,从初一到初二,抑郁呈增长趋势,且性别差异显著,而自伤的增长趋势不明显,但到初二后表现出了明显的性别差异;抑郁和自伤的同时性相关和继时性相关均显著;前测抑郁对后测自伤有明显的预测作用,但前测自伤对后测抑郁的预测作用不明显;父子沟通和母子沟通在前测抑郁与后测自伤水平之间有显著的负向调节作用。     

THE ROLE OF ATTENTION IN THE TREATMENT OF ATTENTION-MAINTAINED SELF-INJURIOUS BEHAVIOR: NONCONTINGENT REINFORCEMENT AND DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIOR

Because there are potentially serious limitations to differential reinforcement of other behavior (DRO) (which is probably the most widely used treatment procedure for behavior problems), we examined an alternative procedure—noncontingent reinforcement (NCR). Three females with developmental disabilities, all of whom engaged in severe self-injurious behavior, participated. During a pretreatment functional analysis, each subject's self-injury was shown to be differentially sensitive to social attention as a maintaining consequence. Next, each subject was exposed to a DRO treatment and an NCR treatment. During DRO, attention was delivered contingent on the absence of self-injury for prespecified intervals. During NCR, attention was delivered on a fixed-time schedule that was not influenced by the subject's behavior. Results showed that both procedures were highly effective in reducing self-injury, probably because the functional reinforcer for self-injury was used during treatment. Furthermore, there was evidence that NCR attenuated several of the limitations of DRO. These results are particularly interesting in light of the long experimental history of NCR as a control rather than as a therapeutic procedure.     

THE USE OF BEHAVIORAL ASSESSMENT TO PRESCRIBE AND EVALUATE TREATMENTS FOR SEVERELY HANDICAPPED CHILDREN

Behavioral assessment procedures were used to prescribe and evaluate treatments of maladaptive behavior for 2 children with severe multiple handicaps. In Experiment 1, the results of an assessment of reinforcer preference were used in conjunction with a functional analysis of the conditions maintaining self-injurious behavior to prescribe a treatment for a child with severe disabilities. The treatment procedure involved the use of a pressure-sensitive microswitch to activate reinforcing stimuli during two solitary conditions, during which self-injurious behavior had occurred at high rates. The results were evaluated with a multiple baseline across settings design and indicated that self-injury decreased with concomitant increases in microswitch activation. Results were maintained at 6 weeks, 8 weeks, and 6 months. In Experiment 2, the results of behavioral assessments of reinforcer preference and self-injurious behavior were combined to develop a treatment for a second severely handicapped child, who exhibited high rates of self-injury in demand situations. This treatment was evaluated with a multiple baseline across tasks design and resulted in the elimination of self-injury for up to 15 months.     

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.     

父母“低头族”对青少年自伤行为的影响:基于体验回避模型的视角

本研究基于自伤的体验回避模型,考察父母“低头族”对青少年自伤行为的影响,并检验焦虑和体验回避的序列中介作用。以808名中学生为被试,采用父母低头族量表、抑郁-焦虑-压力简版量表、接纳与行动问卷第二版和青少年自我伤害行为问卷进行测试,结果发现：（1）父母“低头族”与青少年焦虑、体验回避、自伤行为呈显著正相关;焦虑、体验回避与自伤行为呈显著正相关;（2）焦虑和体验回避在父母“低头族”和青少年自伤行为之间均起部分中介作用;（3）焦虑和体验回避在父母“低头族”和青少年自伤行为之间构成序列中介,即父母“低头族”通过增加青少年的焦虑,从而提高体验回避倾向,进而增加青少年自伤行为。研究从情绪和应对手段角度来考察父母“低头族”对青少年自伤行为的作用机制,对青少年自伤行为的预防和干预具有启示意义。     

父母冲突与青少年自伤的关系:一个有调节的中介模型

以情绪安全感理论为依据考察父母冲突与青少年自伤的关系,并在此基础上提出一个有调节的中介模型,探讨情绪不安全感的中介作用以及情绪调节自我效能感的调节作用。采用整群抽样法对2800名中学生进行问卷调查,结果表明:(1)在所有青少年被试中有自伤行为的比例占41.49%,青少年的自伤水平在年级、学校类型和是否为独生子女这些人口学变量上有显著差异;(2)父母冲突能显著地正向预测青少年的自伤水平,情绪不安全感在两者之间起部分中介作用;(3)控制消极情绪自我效能感对情绪不安全感的中介作用有显著的负向调节作用,只有当控制消极情绪自我效能感很低时,情绪不安全感在父母冲突和青少年自伤水平的中介作用才是显著的。     

TOWARD A FUNCTIONAL ANALYSIS OF SELF-INJURY

This study describes the use of an operant methodology to assess functional relationships between self-injury and specific environmental events. The self-injurious behaviors of nine developmentally disabled subjects were observed during periods of brief, repeated exposure to a series of analogue conditions. Each condition differed along one or more of the following dimensions: (1) play materials (present vs absent), (2) experimenter demands (high vs low), and (3) social attention (absent vs noncontingent vs contingent). Results showed a great deal of both between and within-subject variability. However, in six of the nine subjects, higher levels of self-injury were consistently associated with a specific stimulus condition, suggesting that within-subject variability was a function of distinct features of the social and/or physical environment. These data are discussed in light of previously suggested hypotheses for the motivation of self-injury, with particular emphasis on their implications for the selection of suitable treatments.     

负性生活事件对初中生自我伤害行为的影响:有调节的中介效应

采用负性生活事件量表、自我批评量表、亲子关系量表和青少年自我伤害行为问卷对333名初中生进行测查,探讨负性生活事件对初中生自我伤害行为的影响及作用机制。结果表明:(1)负性生活事件对初中生的自我批评和自我伤害行为均有显著的正向预测作用;(2)自我批评在负性生活事件与初中生自我伤害行为之间起着部分中介作用;(3)负性生活事件和自我批评的关系(中介效应的前半段路径)受到亲子关系的调节,即负性生活事件对自我批评的正向影响随着父子关系和母子关系的增强而减弱。因此,负性生活事件和初中生自我伤害行为之间存在有调节的中介效应。     

Parents’ Experiences of Nonsuicidal Self-Injury Among Adolescents and Young Adults

We assessed the impact of adolescent nonsuicidal self-injury (NSSI) on parents in two studies. In Study 1, 16 Australian parents of adolescents with a history of nonsuicidal self-injury responded to open-ended questions about their child’s nonsuicidal self-injury. Data from 10 of the adolescents were matched with parents’ responses regarding the nature and extent of nonsuicidal self-injury, revealing that parents underestimated the frequency of nonsuicidal self-injury, the age of onset, and the likelihood their child would continue to self-injure. In Study 2, 22 American parents of adolescents with a history of nonsuicidal self-injury participated in interviews about their experiences. Parents in both studies reported changes in the parent–adolescent relationship after self-injury, which posed challenges to the family unit. When professional help had been sought, experiences were largely negative. Results support further investigation into family-based interventions to equip parents with tools to better relate to, and communicate with, their adolescent following self-injury. Results also suggest that mental-health professionals and general practitioners may require further training for nonsuicidal self-injury.     

Callous-unemotional traits,borderline personality,and self-injury in gothic subculture

The present study investigates individual characteristics of a sample of young adults from gothic subculture, in terms of personality traits (i.e., borderline personality and callous-unemotional traits), prevalence and functions of non-suicidal self-injury behaviours (i.e., internal emotion regulation, external emotion regulation, social influence, and sensation seeking). Fifty-one young adults (28 girls and 23 boys, mean age = 26.20, SD = 4.61) were recruited at a gothic meeting in Italy. They completed self-report questionnaires related to self-injury behaviours and self-injury functions, along with measures of borderline personality disorder and callous-unemotional traits. The results indicated that nearly 65% of the participants reported having committed self-injury at least once. Moreover, both bivariate and multivariate analyses indicated that self-injury behaviours were related to borderline personality and internal emotion regulation function. Lastly, association between considered personality traits and self-injury functions were investigated. Overall, results indicated that in gothic subculture self-injury has the function of regulating emotion to maintain the integrity of the Self and is related to the perception of a traumatic reality in which derealization coexists with extreme self-directed aggression.     

Claiming,Resisting, and Exempting Pathology in the Identities of Self-Injurers

For this project, we analyzed in-depth life history materials from interviews with twelve former self-injurers. Eschewing a medical/psychological approach to self-injury, our primary goal was to discover how study participants used the discourse of self-injury as a narrative resource to construct their identity. Our study participants drew on pathology exemplars and alternative frames to make sense of their lives and selves. In this article, the lines between so-called self-injury and other socially sanctioned behaviors became blurred. We call for an approach to the topic that is more consciously aware of the socially constructed nature of the phenomenon.     

青少年自我伤害行为的潜在转变分析:一项纵向研究

研究采用潜在转变分析探究了青少年自我伤害行为的发展。对3600名青少年进行为期18个月的追踪,对其自我伤害行为进行了三次测量。通过纵向数据分析识别出过渡组这一以往研究未发现的群体,该组被试仅出现程度较轻的自我伤害行为,且占总体的比例随时间快速下降。通过转变矩阵解释了过渡组和高发组的不稳定性是自我伤害行为发生率降低的原因,并发现冲动性、负向情绪等个体易感因素比家庭等人际因素对自我伤害行为存在更为显著的预测作用。在性别差异上,女生比男生更容易产生自我伤害行为,也更容易受到各方面因素的影响。最后,文章针对青少年自我伤害行为的预防和控制工作提出了建议。     

A WATER-PROMPTING PROCEDURE FOR THE TREATMENT OF URINARY INCONTINENCE

Based on clinical observations of a naturally occurring phenomenon, a water-prompting procedure was used to facilitate toilet training with a 9-year-old boy with profound mental retardation. Other frequently used toilet-training procedures were either ineffective or were associated with increased self-injury. The water-prompting treatment package may increase continence by eliciting and reinforcing urination under specific stimulus conditions.