Come on in, the Water is Fine: Achieving Mainstream Relevance through Integration with Primary Medical Care

Behavior analysis is a generic science, and Skinner's vision for it was that it would become a mainstream force, relevant for most if not all human concerns, major and minor. Clearly his vision has not been realized. Determining why this is the case would require a complex multifactorial analysis. One likely factor is that the majority of its basic science findings have been obtained from the study of rats and pigeons. Another likely factor, one directly addressed by this paper, is that the majority of its applied science findings have been obtained from the study of people in only one tail of the normal distribution. Regardless, those outside the field see the relevance of behavior analysis to general human affairs as very limited. Whether the path behavior analysis is on will lead to widespread perception of mainstream relevance anytime soon seems doubtful. An alternative route would involve integrating it with a field that has already made the trip successfully. A premier example involves primary medical care. This paper argues for the integration of behavior analysis with pediatric primary care, sketches a method for its accomplishment, and uses diurnal enuresis to illustrate the requirements of the method.     

Autonomic activity, pain, and perceived health in patients on sick leave due to stress-related illnesses

Objective: The aim of the present study was to compare autonomic activity, pressure-pain thresholds, and subjective assessments of health and behavior between patients with stress-related illnesses and healthy control subjects.Methods: Twenty sick-listed patients with stress-related illnesses and 20 age- and gender-matched healthy subjects performed tests of autonomic regulation and algometric tests, and completed questionnaires about physical and mental health and behavioral patterns.Results: Patients exhibited higher autonomic reactivity to cognitive and physical laboratory tasks (p<0.05), and had lower pressure-pain thresholds in the shoulders and lower back than healthy control subjects (p<0.05). Furthermore, the patients rated considerably poorer health and health behavior than the control subjects (p<0.05).Conclusions: The results indicate an engagement of the autonomic nervous system in stress-related illnesses. Furthermore, they show that patients with stress-related illnesses experience symptoms of musculoskeletal pain, and it is therefore recommended that assessments of musculoskeletal pain be incorporated in the clinical examinations and the rehabilitation of patients with stress-related illnesses.     

The Defence Mechanism Test (DMT) revisited: experimental validation using threatening and non‐threatening pictures

Although the Defence Mechanism Test (DMT) has been in use for almost half a century, it is still unclear what it actually measures. The psychodynamic theory on which the test is based states that the threatful DMT pictures activate various defence mechanisms. To test this proposition, the original DMT pictures were redrawn by a professional artist, changing the emotional content without altering the structural properties. In this way, a neutral and a friendly variant were shaped. Sixty participants were randomly assigned to the threatful, neutral, and friendly stimulus conditions. In contrast to predictions made from psychodynamic theory, that the threatful picture would activate more ‘signs of defence’ than the others, the results disclosed that the three conditions activated the same amounts of ‘signs of defence’ and the same levels of various perceptual thresholds. Thus, rather than capturing psychodynamic defence mechanisms, our results suggest that the DMT taps perceptual or information‐processing difficulties in correct identification of brief stimulus exposures regardless of their emotional contents. Copyright © 2002 John Wiley & Sons, Ltd.     

FEED THE HUNGRY BEE: USING POSITIVE PEER REPORTS TO IMPROVE THE SOCIAL INTERACTIONS AND ACCEPTANCE OF A SOCIALLY REJECTED GIRL IN RESIDENTIAL CARE

We studied how rewarding peers for publicly reporting positive aspects of a socially rejected girl's behavior affected her social interactions and acceptance. The results indicated that positive peer reports reduced negative social interactions (to near zero) and increased positive interactions (to above 70%). In addition, social acceptance ratings of the girl increased from pre- to postintervention.     

Maintaining placement for troubled and disruptive adolescents in voluntary residential care: The role of reduced youth-to-staff ratio

We evaluated a program to protect the placements of 23 highly troublesome youth in voluntary residential care by reducing youth-to-staff ratios. Specifically, the youth were moved from regular program homes (with eight youth) to reduced ratio homes (with only four youth) instead of being terminated from the program. We provide evidence supporting the assertion that youth in the study sample were highly troublesome and at high risk for program failure and more restrictive placements. Placement in the reduced ratio homes protected the trouble youths' placement, resulting in an additional mean length of stay of 950 day without an increase in program restrictiveness. Further, the reduced ratio homes increased the chances of success in the program for the study sample to a level equivalent to that for the much less troubled comparison sample. Cost estimates are also provided.     

Influences of Affect Associated with Routine Out-of-Home Activities on Subjective Well-Being

A survey of a random sample of 1,330 Swedish residents assessed the relationships between affect associated with performance of routine out-of-home activities, mood, and judgments of life satisfaction (cognitive subjective wellbeing, CSWB). Regression analyses showed that sociodemographic variables accounted for most variance in CSWB (7%) and least in mood (2%). In agreement with previous research, CSWB increased with income, employment, and cohabiting with a spouse, and had a U-formed relationship with age. Affect associated with routine activities accounted for more variance than the socio-demographic variables in mood (30%) and in CSWB (13%). Mood partially mediated the effect on CSWB of affect associated with the activities. The results suggest that future policy-related research should consider the possibility that community-provided resources that facilitate performance of routine out-of-home activities would increase life satisfaction.     

Pre- and Postpartum Fear of Childbirth in Nulliparous and Parous Women

The link between fear of childbirth and theories of anxiety in general is discussed. A possible expression of trait (T-fear) and state (S-fear) aspects of fear of childbirth was investigated in 77 nulliparous and 85 parous women based on data from gestational week 32, at 2 hours and at 5 weeks after childbirth. Data are based on the State Trait Anxiety Inventory and the Wijma Delivery Expectancy/Experience Questionnaire. According to their scores on the Wijma Delivery Expectancy/Experience Questionnaire during late pregnancy, women were divided into 3 groups: high, moderate and low levels of fear of childbirth. In gestational week 32, women in the low level of fear of childbirth group had lower trait anxiety than those in the moderate level of fear of childbirth group, who had lower trait anxiety than the women in the high level of fear of childbirth group. Nulliparous women had a higher level of fear of childbirth but a lower level of trait anxiety than did parous women. There was a significant decreasing trend in fear of childbirth from 2 hours to 5 weeks after delivery, in a parallel way for all 3 groups. Differences in fear of childbirth between nulliparous and parous women disappeared after delivery. These findings suggest that fear of childbirth comprises a considerable part of T-fear, with the risk of a vicious cycle, i.e. that during labour women experience what they are afraid of, which also influences the women's postpartum cognitive appraisal of the delivery.     

Changing caring behaviours in rehabilitation after a hip fracture – A tool for empowerment?

Different rehabilitation programs after surgery have been presented to improve the outcome for patients with a hip fracture. Empowerment has been suggested as useful, but requires a change in the caring behaviours of health professionals. The aim with this study was to evaluate if training and supervision of the nursing staff could alter caring behaviours. A case-control study of nursing staff treating hip fracture patients was performed at a hospital with two sites. Training and supervision was given to the nursing staff at the intervention site. The intervention focused on creating positive care interaction by using eight guidelines. The evaluation was performed with recordings of a constructed caring situation before training, and observations of care situations at the ward before and after intervention. The results showed no differences at baseline between the two sites in the caring behaviours. After intervention, significant effects of caring behaviours were seen in seven out of eight guidelines, the effect sizes ranged from medium to large. The findings indicate that the nursing staff can change caring behaviours and facilitate the empowerment of patients with a hip fracture.