Decompressing aggressive inpatients: Breaking the aggression cycle to enhance positive outcome

Prolonged seclusions can result in exacerbation of psychotic symptomatology, self-injurious behavior, and increased likelihood of subsequent aggression. A patient's aggression can be contextualized as an interpersonal and cyclic series of events in which both the staff and the patient can play a contributing role. If this cycle can be interrupted, the likelihood of aggression decreases. The authors describe this aggression cycle and some strategies for interrupting it via a “decompression” treatment modality. Four case examples illustrate the range of outcomes achieved with patients who had been secluded for between 2 to 5 years due to their chronic history of aggression. The authors offer suggestions for developing a decompression treatment program.     

Physical Attractiveness and Psychological Adjustment Among Substance Abuse Inpatients: A Longitudinal Study1

Relations between psychological adjustment and physical attractiveness were examined longitudinally in substance abuse inpatients, controlling for the effects of length of drug abuse, length of inpatient stay, age, and socioeconomic status. Measures of adjustment and attractiveness were obtained during the first week of admission and six weeks later (within two weeks of discharge). Regression analyses indicated that initial attractiveness did not predict later adjustment, and initial adjustment did not predict later attractiveness. Partial correlation analyses revealed a positive association between attractiveness and adjustment at the first time point, but not at the later time point. These results suggest that physical attractiveness exerts only a temporary effect on judgments of adjustment in an inpatient setting. Attractiveness may affect decisions made when screening patients at mental health facilities, but may not affect decisions made over the full course of inpatient treatment.     

THE SELF-INJURY TRAUMA (SIT) SCALE: A METHOD FOR QUANTIFYING SURFACE TISSUE DAMAGE CAUSED BY SELF-INJURIOUS BEHAVIOR

A method is described for classifying and quantifying surface tissue damage caused by self-injurious behavior. The Self-Injury Trauma Scale permits differentiation of self-injurious behavior according to topography, location of the injury on the body, type of injury, number of injuries, and estimate of severity. Fifty pairs of independently scored records were subjected to interrater reliability analyses, and the following mean (median) percentage agreement scores were obtained: overall agreement, 97% (98%); location of injury, 99% (100%); type of injury, 96% (100%); number of injuries, 89% (100%); and severity of injury, 94% (100%). Percentage agreement also was calculated for three summary scores: Number Index, 90%; Severity Index, 92%; and Estimate of Current Risk, 100%. Potential applications and limitations of the scale are discussed.     

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.     

EFFECTS AND SIDE EFFECTS OF DRO AS TREATMENT FOR SELF-INJURIOUS BEHAVIOR

A three-part controlled case study is presented in which severe and longstanding self-injurious behavior exhibited by a 9-year-old-boy was treated successfully with differential reinforcement of other behavior. In Phase 1, an experimental analysis demonstrated that the boy's scratching was not maintained by environmental contingencies; instead, it appeared that the self-injurious behavior was a stereotypic (automatically reinforced) response. In Phase 2, the effects of an escalating differential-reinforcement-of-other-behavior schedule mediated through token reinforcement (pennies) were evaluated in a reversal design. Results showed that differential-reinforcement-of-other-behavior eliminated self-injurious behavior very quickly and for periods of time as long as 30 min. A noteworthy side effect observed during Phase 2 was the occurrence of crying behavior following the nondelivery of reinforcement. In Phase 3, the token program was gradually extended in 30-min increments throughout the day. Additionally, results of a brief multielement manipulation showed that the effects of token reinforcement were superior to those of a more easily administered differential reinforcement of other behavior based on social reinforcement, which differed little from baseline.     

USING PARENTS AS THERAPISTS TO EVALUATE APPROPRIATE BEHAVIOR OF THEIR CHILDREN: APPLICATION TO A TERTIARY DIAGNOSTIC CLINIC

We conducted a preliminary analysis of maintaining variables for children with conduct disorders in an outpatient clinic. Eight children of normal intelligence between the ages of 4 and 9 years were evaluated during 90-min sessions. The children's parents conducted the assessments by varying task demands (easy and difficult) and parental attention (attention and no attention) within a multielement design. The assessment focused on appropriate child behavior and was conducted to formulate hypotheses regarding maintaining contingencies. Results demonstrated that the children's appropriate behavior varied across assessment conditions and, for 7 of the 8 children, occurred at a higher rate during one condition than during other conditions. In addition, treatment integrity data demonstrated that parents were able to implement the procedures as intended. The recommended treatments were rated as being both effective and acceptable to parents for up to 6 months following the evaluation. Our results extend previous studies of functional analytic procedures conducted by trained experimenters with severely handicapped children in more controlled settings.     

A delay timer for presenting auditory and visual probes

A circuit designed to present auditory or visual probes is described. The circuit allows the probes to be delayed by a specified amount of time, and the volume (for auditory probes) or intensity (for visual probes) may also be adjusted. The circuit may be triggered by any device capable of emitting an electronic pulse-such as a computer or a tachistoscope.     

Tachistoscopic software for the Hercules display controller

The functions necessary for a high-quality microcomputer emulation of a tachistoscope are summarized. A software package containing an extensive set of tachistoscope-emulation functions for IBM PC-type computers is described. This software gives computers equipped with the Hercules monochrome/graphics display controller the ability to produce fast tachistoscopic presentations of text material.     

Electronic surveys

A programming language and computer system for the design, administration, and distribution of surveys are described. A special-purpose programming language allows the concise definition of a survey. The definition is passed to a program generator that creates a program for presenting questions and gathering answers. Conventions for distribution and collection of surveys are discussed. The system reduces many of the problems associated with conducting a survey.     

Chronic Medical problems,coping resources,and depression: A longitudinal study of rural Tennesseans

This analysis examined chronic medical problems as a risk factor for depressive symptomatology using longitudinal survey data from a sample of rural Tennesseans. Two waves of data (1977 and 1983) were collected on 532 rural Middle-Tennessee residents. An initial investigation found chronic medical problems a powerful predictor of depression. Furthermore, internal and external resources (personal resources and social support) operated as moderating factors between the stress of medical problems and psychiatric impairment. Panel regression analyses indicated that Time 1 depression level as well as medical problems at Time 2 (t2) were significant predictors of depression at t2 in rural areas of the mid-South. Finally, the buffering effects of both social support and personal resources were explored.