Treatment manuals: use in the treatment of bulimia nervosa

As psychology has moved toward emphasizing evidence-based practice, use of treatment manuals has extended from research trials into clinical practice. Minimal research has directly evaluated use of manuals in clinical practice. This survey of international eating disorder professionals examined use of manuals with 259 clinicians’ most recent client with bulimia nervosa. Although evidence-based manuals for bulimia nervosa exist, only 35.9% of clinicians reported using a manual. Clinicians were more likely to use a manual if they were younger; were treating an adult client; were clinical psychologists; were involved in research related to eating disorders; and endorsed a cognitive-behavioral orientation. Clinicians were less likely to use a manual if they provided eclectic psychotherapy that incorporated multiple psychotherapeutic approaches. We conclude that psychotherapy provided in clinical practice often does not align with the specific form validated in research trials, and “eclecticism” is at odds with efforts to disseminate manuals into clinical practice.     

A flipped spoon and chin prompt to increase mouth clean

We treated the liquid refusal of a 15-month-old girl using 2 antecedent manipulations: flipped spoon and chin prompt. Use of the chin prompt in the absence of the flipped spoon failed to produce increases in mouth clean (a product measure of swallowing). By contrast, modest increases in mouth clean resulted from the implementation of the flipped spoon alone. The greatest increases in mouth clean resulted from the combination of the 2 manipulations.     

Children's Road Crossing: A Window Into Perceptual–Motor Development

ABSTRACT— Most research on perceptual–motor development has focused on changes occurring during infancy and toddlerhood. In this paper, we describe our work on the development of perceptual–motor development during late childhood and early adolescence in the context of an important applied problem: bicycling across traffic-filled roads. Specifically, we have examined the gaps between cars that children and adults accept when bicycling across intersections, using an immersive, interactive bicycling simulator. This work highlights both methodological advances in using immersive, interactive virtual environments to study perceptual–motor functioning as well as theoretical advances in understanding the problem of moving the self in relation to other moving objects. We conclude with ideas for future research and practical implications of this work.     

Evaluating and Comparing Interventions Designed to Enhance Math Fact Accuracy and Fluency: Cover,Copy, and Compare Versus Taped Problems

An adapted alternating treatments design was used to evaluate and compare the effects of two procedures designed to enhance math fact accuracy and fluency in an elementary student with low cognitive functioning. Results showed that although the cover, copy, compare (CCC) and the taped problems (TP) procedures both increased the student's math fact accuracy and fluency, TP was more effective as it took less time to implement. Discussion focuses on the need to develop strategies and procedures that allow students to acquire basic computation skills in a manner that will facilitate, as opposed to hinder, subsequent levels of skill and concept development.     

Testing for effects of racial attitudes and visual contrast on the speed of a driver’s response to a pedestrian

Although ethnic minorities are overrepresented in pedestrian-vehicle collisions, previous driving studies did not examine racial attitudes in such collisions. Our objective was to determine whether the speed of a driver’s response to a pedestrian was affected by the driver’s racial attitudes and the contrast between the pedestrian’s skin colour and background. Participants viewed simulated driving scenes of a pedestrian on a road and pressed a button as soon as they saw an obstacle. Visual information, but not racial attitudes, affected the time it took observers to respond to pedestrian and non-pedestrian stimuli in driving scenes. Results indicated that contrast affected response time even when the stimulus was subliminal. We believe this is the first demonstration of contrast effects with subliminal stimuli in a driving context. Results have implications for traffic safety and for methodology used to study racial attitudes.     

Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills

This study evaluated the efficacy of three methods of training community mental health providers (N = 150) in Dialectical Behavior Therapy skills, including a written treatment manual; an interactive, multimedia online training (OLT); and a two-day instructor-led training workshop (ILT). A hybrid design was utilized that incorporated aspects of efficacy and effectiveness trials. Assessments were completed at baseline, post-training, and 30- and 90-days following training. The results indicate that learner satisfaction with the training was highest in OLT and ILT, and both resulted in significantly higher satisfaction ratings than the manual. OLT outperformed ILT and the manual in increasing knowledge of the treatment, whereas ILT and the manual did not differ. All three training methods resulted in comparable increases in clinicians' ability to apply course content in clinical simulations. Overall, the results provide strong support for the efficacy of technology-based OLT methods in disseminating knowledge of empirically supported treatments to community mental health providers, suggesting that OLT may be a high-quality, easily accessible, and affordable addition to traditional training methods.     

AN EVALUATION OF GENTLE TEACHING AND VISUAL SCREENING IN THE REDUCTION OF STEREOTYPY

Gentle teaching and visual screening techniques have been used to control severe behavior problems in persons with mental retardation. An alternating treatments design was used to compare gentle teaching, visual screening, and a task-training condition in the reduction of the high-level stereotypy of 3 persons with mental retardation. Following a baseline phase, a task-training condition using standard behavioral techniques was implemented to establish the effects of training the subjects on the tasks. Results showed a modest decrease in stereotypy. This phase was followed by an alternating treatments phase in which visual screening, gentle teaching, and baseline conditions were compared. Both procedures were superior to the control condition in reducing stereotypic behavior, with visual screening being more effective than gentle teaching. When compared with data from the prior phase, gentle teaching was found to be more effective than task training for 2 subjects but less effective for the 3rd, whose stereotypy increased during gentle teaching. Two succeeding phases in which visual screening was implemented across two and then all three daily conditions reduced stereotypy further to near-zero levels. An additional phase with 1 subject demonstrated that the treatment effects of visual screening were easily replicated across therapists. Mixed and idiosyncratic changes in collateral behaviors occurred. For example, “bonding,” the goal of gentle teaching, occurred at the same low levels under both treatments, contrary to the predictions of gentle teaching's proponents. The results indicate that gentle teaching may not be the universal treatment of choice for stereotypy its proponents suggest, and that it requires further empirical evaluation.     

SELF-RECORDING OF ATTENTION VERSUS PRODUCTIVITY

We investigated the relative effects of self-recording of attentive behavior and self-recording of academic productivity with 5 upper elementary-aged special education students in their special education classroom. Following baseline, both self-recording treatments were introduced according to a multielement design. After the multielement phase, we assessed the pupils' performance under a choice condition, faded the overt aspects of the treatment program according to a withdrawal design, and probed maintenance over 5 weeks. Results revealed that both treatments produced clear improvements in arithmetic productivity and attention to task, neither treatment was clearly and consistently superior to the other, pupils preferred the self-recording of attention treatment, the effects were maintained for all pupils, achievement test scores improved, and pupils generally recorded accurately.     

MULTIPLE TREATMENT INTERFERENCE IN THE ALTERNATING TREATMENTS DESIGN AS A FUNCTION OF THE INTERCOMPONENT INTERVAL LENGTH

In experimental designs requiring the administration of more than one treatment to the same subject(s), the effect of one treatment may be influenced by the effect of another treatment (Campbell & Stanley, 1963), a phenomenon known as multiple treatment interference. We conducted two studies in which multiple treatment interference in an alternating treatments design was shown to be a function of the length of the intercomponent interval (ICI) separating treatment conditions. In the first study, we evaluated the effects of four different treatments on the mouthing of a severely retarded boy. Under a 1-min ICI no consistent differential responding to treatment was obtained. Differential responding emerged when the ICI was increased from 1 min to 120 min, thus suggesting multiple treatment interference in the lack of differential responding under a 1-min changeover interval. Functional control of the nondifferential and differential responding as a function of the ICI length was replicated in a reversal phase. In the second study, we compared two treatment procedures for the disruptive noncompliant behavior of a moderately retarded boy. Multiple treatment interference (i.e., the lack of differential responding) occurred with the 1-min intercomponent interval. An increase to a 120-min ICI again resulted in differential responding. A replication of multiple treatment interference by a reversal to a short interval phase was not achieved in the second subject. Results of this study support much of the basic literature on discrimination and multiple treatment interference. Major findings of this study are twofold: Multiple treatment interference can depend on the length of the changeover interval between treatments and multiple treatment interference can take the form of a lack of differential responding to various treatments. Implications for future research are discussed.     

Examining Transfer Effects of Dual-Task Training Protocols for a Complex Locomotor Task

Training protocols designed to improve dual-task performance of an obstacle crossing and auditory Stroop task (OBS+Stroop) were tested. In Experiment 1, following baseline collection of OBS+Stroop trials, proximally related walking training was performed, and participants were then retested on the OBS+Stroop test. After training, participants adopted a more cautious obstacle crossing strategy, indicating a potentially safer navigation strategy. Transfer effects from distally related training were then examined (Experiment 2); a computer game training paradigm was examined using the same testing protocol as Experiment 1. Computer training demonstrated improved dual-task performance on some measures, but did not induce a more cautious stepping strategy. Results indicate that dual-task training needs to be similar to targeted tasks to yield reliable, positive training outcomes.