OPERANT TREATMENT OF OROFACIAL DYSFUNCTION IN NEUROMUSCULAR DISORDERS

The popularity and reported success of biofeedback treatment for neuromuscular disorders has occurred despite a lack of research identifying the critical variables responsible for therapeutic gain. In this study, we assessed the degree to which severe neurological dysfunction could be improved by using one of the components present in all biofeedback treatment, contingency management. Three cases of orofacial dysfunction were treated by reinforcing specific improvements reliably detectable without the use of biofeedback equipment. The results showed that contingency management procedures alone were sufficient to improve overt motor responses but, unlike biofeedback treatment, did not produce decreases in the hypertonic muscle groups associated with the trained motor behavior. The findings suggest that sophisticated, expensive biofeedback equipment may not be necessary in treating some neuromuscular disorders and that important clinical gains may be achieved by redesigning the patient's daily environment to be contingently therapeutic, rather than only accommodating the disabilities of the physically handicapped.     

BEHAVIOR ANALYSIS OF MOTION CONTROL FOR PEDIATRIC NEUROIMAGING

Magnetic resonance imaging is a promising technological advance used for research and diagnosis of disease. The procedure has no risks, except when uncooperative patients require sedation. Four normal children participated in simulated scans to study the effects of (a) antecedent changes in the imaging environment and (b) operant conditioning of movement inhibition. Changing the environment can decrease movement, but operant contingencies were necessary to decrease movement to a level that, in most cases, would allow the procedure to occur without sedation.     

Resilience in adolescence: Gender differences two years after the earthquake of L’Aquila

The aim of this study was to evaluate the impact of L’Aquila earthquake (Italy) on Resilience and Coping 2 years after the earthquake in a high school sample. Three hundred and twenty-four male and female students exposed to the earthquake and 147 not-exposed have been assessed with the Resilience Scale for Adolescents (READ) and the Brief COPE. The two way ANOVAs for gender by exposure level to the distressing event showed statistically significant interactions with males exposed to the earthquake reporting consistently higher READ factor scores. Problem-focused but not emotion-focused coping strategies showed a similar pattern. These findings are compatible with a resilient ‘protective mechanism’ for males.     

COMPLIANCE TRAINING AND BEHAVIORAL COVARIATION IN THE TREATMENT OF MULTIPLE BEHAVIOR PROBLEMS

The present study investigated the use of a compliance-training procedure and its effect on untreated deviant child behaviors. Three children, each generally noncompliant to adult requests and with several additional problems, such as crying, aggression, and self-injurious behavior, were trained in the compliance procedure under a multiple-baséline design across therapists. Compliance was defined as the correct response to prespecified requests. Other classes of deviant child behavior were measured continuously throughout the study but not directly reinforced. The results of the study showed that (a) increases in compliance to requests were directly related to the contingencies employed; (b) decreases in untreated deviant behaviors occurred when compliance increased, even though no direct contingencies had been placed on these behaviors; and (c) the relationship between untreated deviant behaviors and compliance appeared to be maintained by a different set of events in each of the three children. The results are discussed in terms of behavioral covariation and generalization.     

Integrating functional neuroimaging and human operant research: brain activation correlated with presentation of discriminative stimuli

Results of numerous human imaging studies and nonhuman neurophysiological studies on "reward" highlight a role for frontal, striatal, and thalamic regions in operant learning. By integrating operant and functional neuroimaging methodologies, the present investigation examined brain activation to two types of discriminative stimuli correlated with different contingencies. Prior to neuroimaging, 10 adult human subjects completed operant discrimination training in which money was delivered following button pressing (press-money contingency) in the presence of one set of discriminative stimuli, and termination of trials followed not responding (no response-next trial contingency) in the presence of a second set of discriminative stimuli. After operant training, subjects were instructed to memorize a third set of control stimuli unassociated with contingencies. Several hours after training, functional magnetic resonance imaging was performed while subjects viewed discriminative and control stimuli that were presented individually for 1,500 ms per trial, with stimulus presentations occurring, on average, every 6 s. Activation was found in frontal and striatal brain regions to both sets of discriminative stimuli relative to control stimuli. In addition, exploratory analyses highlighted activation differences between discriminative stimuli. The results demonstrate the utility of coupling operant and imaging technologies for investigating the neural substrates of operant learning in humans.     

EFFECTS OF SIGNALING INVASIVE PROCEDURES ON A HOSPITALIZED INFANT'S AFFECTIVE BEHAVIORS

We report the effects of using a visual and auditory stimulus signaling impending painful medical procedures versus “safe” periods on the affective behavior of a hospitalized infant. The results of a reversal design suggested that the signaling procedures increased positive behaviors and decreased negative behaviors during both noninvasive and invasive caregiver events.     

I Know That my Redeemer Lives: Relational Perspectives on Trauma, Dissociation, and Faith

This paper focuses the lens of multiplicity on patients’ religious experience in relation to the psychic realities of early or pervasive trauma, where dissociation is not just a normal means of self-regulation, but becomes an entrenched structuring mechanism through which the trauma survivor experiences every relationship, including any relationship to God. What might God or faith look like from the perspective of the traumatized self? This paper considers issues of multiplicity and dissociation as they affect the processing of religious or spiritual experience, with a few brief clinical illustrations, and offers a reading of the biblical book of Job as a metaphor for the inner world of the survivor of early trauma.     

Multiple Selves, Multiple Gods? Functional Polytheism and the Postmodern Religious Patient

The experience of self as multiple and the sense of self as unified and continuous are both experiential realities with equal psychological importance. Clinically, appreciation of both the multiplicity and unity of self engenders a corresponding attention to the “functional polytheism” in the religious lives of patients. In both the psychological and religious realms, there needs to be some ground beneath us when we are standing in the spaces between multiple self-states and multiple god-states.