Correspondence

The American Journal of Psychoanalysis -     

DIRECT AND COLLATERAL EFFECTS OF RESTRAINTS AND RESTRAINT FADING

Mechanical restraints are commonly used to reduce the risks associated with severe self-injurious behavior (SIB), but may result in movement restriction and adverse side effects (e.g., bone demineralization). Restraint fading may provide a method for decreasing SIB while increasing movement and reducing these side effects. In the current investigation, rigid arm sleeves and restraint fading (gradually reducing the rigidity of the sleeves) were used with 3 clients who engaged in hand-to-head SIB. Restraints and fading reduced the hand-to-head SIB of all clients. However, for 1 client, the addition of a water mist procedure further reduced SIB to near-zero levels. For a 2nd client, another form of SIB developed that was not prevented by the rigid sleeves. For a 3rd client, a topography of SIB that was not physically prevented by the rigid sleeves was also reduced when restraints and fading were introduced.     

BALANCING SOCIAL ACCEPTABILITY WITH TREATMENT EFFECTIVENESS OF AN INTRUSIVE PROCEDURE: A CASE REPORT

The debate over social acceptability of intrusive procedures has led some school districts to adopt policies allowing punishment for only the most extreme forms of destructive behavior. We investigated the effectiveness of selectively implementing punishment for only the most severe topographies of aggression and property destruction, while less extreme behaviors were ignored. Results indicated that severe behaviors were reduced to near-zero levels only when both severe and less severe behaviors were similarly punished.     

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.     

The distribution postulate in Bohm's theory

On Bohm's formulation of quantum mechanics particles always have determinate positions and follow continuous trajectories. Bohm's theory, however, requires a postulate that says that particles are initially distributed in a special way: particles are randomly distributed so that the probability of their positions being represented by a point in any regionR in configuration space is equal to the square of the wave-function integrated overR. If the distribution postulate were false, then the theory would generally fail to make the right statistical predictions. Further, if it were false, then there would at least in principle be situations where a particle would approach an eigenstate of having one position but in fact always be somewhere very different. Indeed, we will see how this might happen even if the distribution postulate were true. This will help to show how loose the connection is between the wave-function and the positions of particles in Bohm's theory and what the precise role of the distribution postulate is. Finally, we will briefly consider two attempts to formulate a version of Bohm's theory without the distribution postulate.     

The mediating role of anxiety in self-reported somatic complaints of depressed adolescents

This study examined the mediating role of anxiety in the self-reports of somatic complaints in 96 depressed adolescent inpatients. Sixty-four subjects with major depressive episodes and comorbid anxiety disorders (MDE-A) determined from the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) reported significantly more somatic complaints than 32 adolescents having major depressive episodes without comorbid anxiety (MDE). An analysis of covariance demonstrated that, with anxiety symptoms controlled, MDE and MDE-A groups did not differ significantly in somatic complaints. A hierarchical multiple-regression analysis revealed that, with demographic and anxiety symptoms controlled, depressive symptoms did not contribute to the explanation or prediction of somatic complaints. The results suggest that anxious, but not depressive symptoms, are independently associated with somatic complaints. The results are discussed in light of new affective models of psychopathology.     

Contextual influences on interactive processing: Effects of discriminability,quantity, and uncertainty

Three contextual factors—(1) the discriminability of stimuli in pitch, (2) the number of stimuli differing in pitch, and (3)the uncertainty regarding which stimuli or tasks would appear—were manipulated as subjects performed speeded loudness classifications in each of six experiments. The magnitude of Garner interference and effects of congruity were used to gauge the degree of interactive processing. Enhancing pitch discriminability caused monotonic increases in interference and congruity. Stimulus-task uncertainty mediated the changes in Garner interference wrought by increased discriminability. Uncertainty also caused a surprising shift in congruity from strongly positive to strongly negative as uncertainty grew. Increasing stimulus quantity lowered interference, but had inconsistent effects on congruity. Regression analyses suggested that, collectively, these three contextual variables underlie most failures of selective attention in speeded classification.