Interaction-priming: a method of reinstating patient-family relationships

The probability of successful discharge for long-term mental hospital patients has been found to depend on strong family and social relationships (Chapman, Day and Burstein, 1961 ; Chase and Silverman, 1943; Paul, 1969; Meichenbaum, 1966; Ullmann, 1967). Yet, long-term institutionalization often results in the weakening of these relationships. These findings suggest that successful discharge would be facilitated by procedures that maintained or restored these social relationships. The present study attempted to develop such a procedure, based on the principles of Response Priming (O'Brien, Azrin and Henson, 1969) and Reinforcer Sampling (Ayllon and Azrin, 1968). Response Priming views complex behavior such as family visits as chains of responses and states that the probability of the completion of the chain (visit) increases during later portions of the chain. The present procedure applies this principle by not requiring visitors to engage in those behaviors remote from the completion of the chain, but rather, by making visits available to them at the terminal portion of the chain. This was done by not requiring visitors to come to the hospital to visit the patient, but rather, by directly transporting the patient to the visitor's home. The Reinforcer Sampling rationale (Ayllon and Azrin, 1968) suggests that future visits would likely increase if visits were reinforcing to the family and the patient. Thus, the patients' behavior was analyzed during visits in the families' homes. Between visits, instruction was given to the patients for improving the reinforcing quality of these types of behavior for subsequent visits. The rationale was that the Response Priming Procedure would produce visits and the Reinforcer Sampling Procedure would show the families and patients that being together was enjoyable. The relationships should, therefore, be maintained and, hopefully, thereby increase the likelihood of successful discharge for the long-term hospitalized patients.     

Reciprocity counseling: A rapid learning-based procedure for marital counseling

Existing marital counseling procedures have not been experimentally evaluated or generally have not been based on an experimentally derived theory. The present study formulated a model of marital discord based on reinforcement theory, developed a marital counseling procedure based on that theory and experimentally evaluated its effectiveness. The model viewed marital discord as the resultant of non-reciprocated reinforcement. The counseling procedures attempted to establish general marital reciprocity of reinforcement by teaching reciprocity in several specific areas of marital unhappiness. The reciprocity procedure was conducted for about 3–4 weeks with 12 couples, after first conducting a catharsis-type counseling as a control procedure. The results showed that the reciprocity procedure increased reported marital happiness, whereas the control procedure did not. Once reciprocity was achieved in a specific problem area, the benefits generalized somewhat to other yet-to-be counseled areas. The increase in marital happiness occurred for each of the specific areas of marital interaction, for 96 per cent of the clients, and was maintained and increased during the available follow-up period. These results indicate that the procedure is an effective, rapid and enduring method of producing marital happiness.     

Habit-reversal: A method of eliminating nervous habits and tics

No clinical treatment for nervous habits has been generally effective. The present rationale is that nervous habits persist because of response chaining, limited awareness, excessive practice and social tolerance. A new procedure was devised for counteracting these influences: the client practiced movements which were the reverse of the nervous habit, he learned to be aware of each instance of the habit and to differentiate it from its usual response chain and he was given social approval for his efforts to inhibit the habit. The treatment was given during a single session to 12 clients who had diverse nervous habits such as nail-biting, thumb-sucking, eyelash-picking, head-jerking, shoulder-jerking, tongue-pushing and lisping. The habits were virtually eliminated on the very first day for all 12 clients and did not return during the extended follow-up for the 11 clients who followed the instructions.     

Improvements in the community-reinforcement approach to alcoholism

This study evaluated a modified Community-Reinforcement program for treating alcoholics. The previously tested Community-Reinforcement program included special job. family, social and recreational procedures and was shown to reduce alcoholism. To increase the effectiveness of the program further, the present study incorporated a Buddy system, a daily report procedure, group counseling, and a special social motivation program to ensure the self-administration of Disulfiram (Antabuse). The alcoholics who received the improved Community-Reinforcement program drank less. worked more, spent more time at home and less time institutionalized than did their matched controls who received the standard hospital treatment including Antabuse in the usual manner. These results were stable over a 2-year period. The program appeared even more effective and less time-consuming than the previous program. The present results replicate the effectiveness of the Community-Reinforcement program for reducing alcoholism and indicate the usefulness of the additions to the program.     

Habit reversal treatment of thumbsucking

About 40% of young children suck their thumbs, an action which is associated with dental problems and for which intra-oral devices have been the most effective treatment. The present study of 30 thumbsucking children evaluated the habit reversal treatment which included competing response training, parental support, and stimulus identification during a single session plus follow-up maintenance by the parent. Habit reversal training reduced thumbsucking by 92% in the first week, 95% in the fourth month, and 89% at the 20-month follow-up. A comparison treatment by a bitter tasting substance produced a reduction of about 35%.