Cognitive Behavioral Therapy for Insomnia in Older Adults

Insomnia is associated with significant morbidity and is often a persistent problem, particularly in older adults. It is important to attend to this complaint and not assume that it will remit spontaneously. In many cases, unfortunately, insomnia remains unrecognized and untreated, often because it is presumed that insomnia is an inevitable consequence of aging. Although the sleep structure naturally changes with advancing age, these changes are not necessarily associated with complaints of poor sleep, distress, or daytime consequences, while chronic insomnia clearly is. There is increasing evidence that cognitive behavioral therapy (CBT) is effective for the management of chronic insomnia in the elderly and that it is of significant benefit for insomnia comorbid with medical and psychological conditions, also more prevalent in older age. The aim of this article is to familiarize clinicians working with older adults with the different components of CBT for insomnia and how to adapt the treatment to this population. A clinical case and session-by-session implementation of CBT for insomnia are described to illustrate information and guidelines provided in this article.     

Using the impact of event scale to evaluate distress in the context of genetic testing for breast cancer susceptibility

The data obtained with two forms of the Impact of Event Scale were compared, one referring to a BRCA1/2 test result (IES-T) and another to cancer (IES-C). The sample consisted of 272 women with a family history suggestive of a BRCA1/2 mutation who underwent genetic testing and received results: noncarrier, carrier, or inconclusive. Globally, mean scores on the IES-C form were higher than those obtained on the IES-T form. Among carriers of a BRCA1/2 mutation, mean scores on the two forms were similar and agreement was good, as measured by the intraclass correlation coefficient (.83; 95% 95% CI=.72, .91). Agreement between the forms was poor to fair among noncarriers (ICC= .38; CI= .15, .57) and women with an inconclusive result (ICC= .40; 95% CI= .26, .52). Having had cancer increased total scores but had little influence on agreement between scores on forms. These findings highlight the importance of carefully selecting the form of the Impact of Event Scale in the context of genetic testing for breast cancer susceptibility.     

Reduction of unsafe eating in a patient with esophageal stricture.

Previous research has demonstrated the efficacy of behavioral interventions in teaching self-feeding skills as well as in reducing inappropriate self-feeding behavior. The purpose of this study was to extend previous research on the use of prompting and reinforcement in reducing unsafe eating behaviors to the treatment of an adolescent with developmental disabilities and esophageal stricture. A behavioral assessment and treatment using prompting and reinforcement were shown to be effective in decreasing bite rate, decreasing bite size, and increasing the number of chews per bite.     

Two-stage model of visual backward masking: Sensory transmission and accrual of effective information as a function of target intensity and similarity

A functional model is used to describe the effect of target intensity and target-set similarity on backward visual masking. The model consists of two distinct stages of visual information processing. The first stage is related to sensory transduction and transmission and is assumed to require a finite and measurable amount of time during which performance-remains at chance. The second stage, associated with central processing, is characterized by a negatively accelerated growth function reflecting the accrual of effective information. Results show that the duration of the transmission stage is inversely related to target intensity. Surprisingly, the rate of information accrual is an interactive function of both target intensity and target-set similarity. The pattern of results is consistent with the interpretation that both intensity and similarity mediate their effect through a common mechanism—the accrual of effective information.     

FUNCTIONAL CONSIDERATIONS IN THE USE OF PROCEDURAL TIMEOUT AND AN EFFECTIVE ALTERNATIVE1

Two single-subject experiments were conducted with students in special preschool classes. In Experiment I, the subject's disruptive, appropriate, and inappropriate play behaviors were measured as a function of three independent variables: reinforcement, a typical timeout procedure, and regularly paced teacher instructions. In an ABA reversal within a multiple baseline across two teachers, all three independent variables comprised the A conditions and procedural timeout was omitted in B. Experiment II examined a second subject's appropriate and inappropriate eating as a function of the same three variables. Two teachers conducted baseline and paced instruction-plus-reinforcement conditions in multiple baseline across teachers. Subsequently, one teacher performed a series of reversals and replications with various combinations of a typical timeout procedure and reinforcement mixed with paced instructions. The results of both experiments suggest that timeout did not produce response decrement in a punishment paradigm, but rather produced response increment in a negative reinforcement paradigm. These results prevailed, even though a reinforcer was operating in the environment before introducing timeout. Paced instructions (delivering instructions to the child at a set pace regardless of the child's behavior) appears to be an alternative when timeout is not effective and, in conjunction with reinforcement, was demonstrated to reduce inappropriate behavior to near zero.     

On the difficulty of noticing obvious features in patient appearance

Medical students and experts were given head-and-shoulder photographs of patients, each showing a key feature of the patient's problem. Three quarters of these pictures were taken from textbooks. Noticing these supposedly obvious features was difficult and strongly influenced by contextual factors. Both experts and students gained about 20% in diagnostic accuracy by having the key features verbally described for them, although these were clearly visible on the photographs. Conversely, both experts and students reported seeing more of these features when the correct diagnosis was suggested to them. This facilitation resulted from an increase in sensitivity to depicted features, rather than a response bias. The properties of these features that allow such failures of noticing are discussed.     

The effects of transition to technician‐delivered telehealth ABA treatment during the COVID‐19 crisis: A preliminary analysis

Telehealth delivery of applied behavior analysis treatment has focused on supervision or staff and parent training, rather than the direct delivery of treatment to clients. The novel coronavirus (COVID‐19) crisis had the potential to significantly disrupt access to direct treatment for individuals with autism. We report a sample of 17 cases that transitioned from in‐person to telehealth delivery of treatment when shelter‐in‐place orders were issued. Of these cases, 76% of participants transitioned to technician‐delivered telehealth services whereas the rest transitioned to a caregiver‐implemented telehealth model. Participants continued to access a similar dosage of treatment hours per week in spite of the treatment model transition (in‐person M = 12; telehealth M = 11) and maintained or improved correct independent responding across all targets from in‐person treatment (M = 75%) to telehealth treatment (M = 80%). These findings provide initial evidence that some clients with autism benefit from technician‐delivered telehealth services.     

Predicting workplace aggression: a meta-analysis

The authors conducted a meta-analysis of 57 empirical studies (59 samples) concerning enacted workplace aggression to answer 3 research questions. First, what are the individual and situational predictors of interpersonal and organizational aggression? Second, within interpersonal aggression, are there different predictors of supervisor- and coworker-targeted aggression? Third, what are the relative contributions of individual (i.e., trait anger, negative affectivity, and biological sex) and situational (i.e., injustice, job dissatisfaction, interpersonal conflict, situational constraints, and poor leadership) factors in explaining interpersonal and organizational aggression? Results show that both individual and situational factors predict aggression and that the pattern of predictors is target specific. Implications for future research are discussed.     

Behavior analytic contributions to public health and telehealth

The Journal of Applied Behavior Analysis is launching a special series on the topics of public health and telehealth. The special series begins with the articles in this issue and will continue for the next 2 to 3 issues with an open submission window until September 1, 2020. Behavior analysis has much to offer with respect to public health and much to gain from continued and expanded use of telehealth. This paper outlines the importance of these topics in the current crisis and in our ongoing evolution as a field. The historical literature in behavior analysis is reviewed for each topic along with suggestions for future research. The articles from the special series will be combined with historical contributions from JABA into a virtual issue. We encourage continued submissions on these topics even after the special series is completed as future papers will also be incorporated into the special issue.     

Invisible displacement understanding in domestic dogs (<Emphasis Type="Italic">Canis familiaris</Emphasis>): the role of visual cues in search behavior

Recently, (Collier-Baker E, Davis JM, Suddendorf T (2004) J Comp Psychol 118:421–433) suggested that domestic dogs do not understand invisible displacements. In the present study, we further investigated the hypothesis that the search behavior of domestic dogs in invisible displacements is guided by various visual cues inherent to the task rather than by mental representation of an object’s past trajectory. Specifically, we examined the role of the experimenter as a function of the final position of the displacement device in the search behavior of domestic dogs. Visible and invisible displacement problems were administered to dogs (N = 11) under two conditions. In the Visible-experimenter condition, the experimenter was visible whereas in the Concealed-experimenter condition, the experimenter was visibly occluded behind a large rigid barrier. Our data supported the conclusion that dogs do not understand invisible displacements but primarily search as a function of the final position of the displacement device and, to a lesser extent, the position of the experimenter.