On seeing oneself as “left out”: The chronically complaining patient in psychotherapy

A clinical observation regarding patients who complain about feeling left out and/or second best provides the framework for this paper. What is expressed is a form of separation anxiety coupled with a loser self-concept. It is suggested that these patients represent a milder form of the moral masochism. Early theoretical formulations include Freud and his emphasis on the superego and Reich's emphasis on the masochist's fear of being left alone. Kramer's little man phenomenon is an example of a more current theoretical formulation which takes account of the complexities of the ego, and composite self and identity in the clinical phenomena observed. A case of a latency-aged child is provided.     

One-session cognitive treatment of dental phobia: preparing dental phobics for treatment by restructuring negative cognitions

The purpose of this study was to investigate the effectiveness of a single session of cognitive restructuring in a sample of phobic dental patients. Fifty-two patients were randomly assigned to one of three conditions: cognitive restructuring (modification of negative cognitions), provision of information (about oral health and dental treatment), and a waiting list control condition. Both interventions maximally lasted one hour. In comparison with the waiting list control condition and the information intervention condition, the cognitive intervention condition not only showed a large decrease in frequency and believability of negative cognitions, but also exhibited a clear decline in dental trait anxiety. Analysis at a follow-up of one year demonstrated a further, drastic reduction in dental anxiety in both intervention conditions, wherein the difference among these conditions was not maintained. It is concluded that it is possible to obtain substantial reductions of dental trait anxiety through a single session of cognitive restructuring. Nevertheless, repeated exposure to the dental situation seems necessary for a further reduction of anxiety.     

Treatment of suicidal patients: a risk-benefit analysis

A therapist may be held liable when a patient commits suicide if previous suicidal tendencies were observed but reasonable precautions were not taken. In order to reduce liability and enhance treatment effectiveness, therapeutic decisions can be critiqued by estimating the risks and benefits associated with different courses of action. An evaluation of risks and benefits can be used to guide decisions regarding assessment, hospitalization, medications, and discharge from the hospital. A risk-benefit analysis can help therapists utilize a broad range of treatment options while allowing patients the maximum degree of autonomy. Additionally, all aspects of treatment should be well documented, including information about the specific course of action chosen, other treatment options considered, and the therapeutic rationale for deciding which treatment plan was best suited to the patient's needs.     

Child abuse and neglect by parents with disabilities: A tale of two families

Two families, in which the children had been placed in foster care due to abuse and neglect by parents who had disabilities, were studied. In the first case, the mother was instructed in skills that our assessment suggested were important for her child's survival. The mother readily acquired and applied these skills, a fact reflected both in changes in her behavior and in changes in the child's well-being. In the second case, the parent's incremental resumption of child custody was made contingent upon completion of relevant parenting tasks. Initially, improvements in the completion of such tasks were evident, but over time and with the onset of militating factors, no further progress was made and all parental rights were terminated. The implications of these cases for behavior analysis and the effort to reunite and preserve families are discussed.     

The paradox of preference for unreliable reinforcement: The role of context and conditioned reinforcement

We discuss Belke and Spetch's (1994) work on choice between reliable and unreliable reinforcement. The studies by Belke and Spetch extend a line of basic research demonstrating that under certain experimental conditions in a concurrent chains procedure, pigeons prefer an alternative that produces unreliable reinforcement. The authors describe the variables that influence preference for unreliable reinforcement, including the signaling and the duration of the reinforcement schedules, the context in which the signaling stimuli occur, and the effects of conditioned reinforcement. Hypothetical applied examples that address these variables are provided, and their influence on preference for unreliable reinforcement in humans is discussed. We conclude by suggesting a line of applied research to examine the relationship between these variables and a preference for unreliable reinforcement.     

Comparing interspersed requests and social comments as antecedents for increasing student compliance

Two students were alternately presented with interspersed high-compliance requests and social comments as antecedents to low-compliance requests. An initial comparison demonstrated similar positive effects on compliance for interspersed requests and social comments. A second analysis indicated that the effectiveness of social comments for increasing compliance was related to the time interval between social comments and low-compliance requests.     

Prevalence of the extinction burst and its attenuation during treatment

Although extinction has been an effective treatment for a variety of behavior disorders, its use may be associated with several adverse side effects, the most common being an initial increase in the frequency of the target response, called an "extinction burst." We attempted to determine the prevalence of the extinction burst in applied research and its possible attenuation with other operant procedures. An analysis of 113 sets of extinction data indicated that bursting may not be as common as previously assumed (it occurred in 24% of the cases) and may be less likely when extinction is implemented with alternative procedures rather than as the sole intervention (bursting was evident in 12% of the former cases and 36% of the latter).     

ACHIEVING AND MAINTAINING COMPLIANCE WITH THE KETOGENIC DIET

The ketogenic diet, a treatment for intractable epilepsy, is rarely initiated because it requires strict compliance with a diet that is perceived to be unpalatable. In a case study of a 15-year-old girl with uncontrolled epilepsy, we used a stimulus-choice procedure to assess relative preferences of 33 foods from the diet and to develop two treatments based on Premack's principle. The results of a multielement analysis showed that both treatments increased dietary compliance. Compliance was maintained with generalization of treatment across settings, and was associated with a 40% reduction in seizures.     

Predicting and scaling hens' preferences for topographically different responses

Six hens were exposed to several concurrent (second-order) variable-interval schedules in which the response requirements on the alternatives were varied. The response requirements were one key peck versus five key pecks, one key peck versus one door push, and five key pecks versus one door push. Response- and time-allocation ratios undermatched the obtained reinforcement ratios but were well described by the generalized matching law. Time and response bias estimates from two pairs of response requirements were used to predict bias in the third pairing. The predicted values were close to those obtained; this result supports the notion that both numerically and topographically different responses act as constant sources of bias within the generalized matching law. The differences between the response and time biases could be accounted for by the different times needed to complete each response requirement. The results also suggest that the door push is a useful operant for research with domestic hens.     

Food-deprivation effects on punished schedule-induced drinking in rats.

Food-deprived rats (at 80% of their free-feeding weights) were exposed to a fixed-time 60-s schedule of food-pellet presentation and developed schedule-induced drinking. Lick-dependent signaled delays (10 s) to food presentation led to decreased drinking, which recovered when the signaled delays were discontinued. A major effect of this punishment contingency was to increase the proportion of interpellet intervals without any licks. The drinking of yoked control rats, which received food at the same times as those exposed to the signaled delay contingency (masters), was not consistently reduced. When food-deprivation level was changed to 90%, all master and yoked control rats showed decreases in punished or unpunished schedule-induced drinking. When the body weights were reduced to 70%, most master rats increased punished behavior to levels similar to those of unpunished drinking. This effect was not observed for yoked controls. Therefore, body-weight loss increased the resistance of schedule-induced drinking to reductions by punishment. Food-deprivation effects on punished schedule-induced drinking are similar to their effects on food-maintained lever pressing. This dependency of punishment on food-deprivation level supports the view that schedule-induced drinking can be modified by the same variables that affect operant behavior in general.