REVIEW OF HEYMAN'S ADDICTION: A DISORDER OF CHOICE

Gene Heyman's Addiction: A Disorder of Choice (2009) advances the important, albeit controversial, view that addiction is not a chronic, relapsing brain disease, but instead is an example of typical everyday choice that is both voluntary and self‐destructive. This review highlights Heyman's arguments for conceptualizing addiction as choice and discusses the utility of the treatment implications that are derived from the melioration model in which Heyman frames addiction. Self‐control and behavioral economics are presented as additional complementary frameworks for understanding addiction as choice, from which pragmatic, evidence‐based treatments for addiction (e.g., contingency management) might more easily be derived.     

SAVING THE BEST FOR LAST? A CROSS-SPECIES ANALYSIS OF CHOICES BETWEEN REINFORCER SEQUENCES

Two experiments were conducted to compare choices between sequences of reinforcers in pigeon (Experiment 1) and human (Experiment 2) subjects, using functionally analogous procedures. The subjects made pairwise choices among 3 sequence types, all of which provided the same overall reinforcerment rate, but differed in their temporal patterning. Token reinforcement schedules were used in both experiments and the type of exchange schedule varied across blocks of sessions. Some conditions permitted immediate exchange of tokens for consumable reinforcers (food for pigeons, video access for humans); in other conditions, tokens accumulated and were exchanged for consumable reinforcers only at the end of the sequence. Choice patterns in the immediate-exchange conditions were generally similar across species, with both pigeons and humans preferring sequences with the shortest delay to the initial reinforcer in the series. The results are broadly consistent with models of temporal discounting expanded to include the impact of sequences of delayed reinforcers acting in parallel from the time of the choice. Preferences were less consistent with discounting models in the delayed exchange conditions. Questionnaire data gathered at the end of the experiment were consistent with prior results of questionnaire studies, but showed no straightforward relation to the observed choice patterns, urging caution in the extrapolation of results from one decision-making domain to the other.     

Looking Ahead: Questions for and About Behavioral Scientists and Practitioners

In this article Robin B. Jarrett reflects on the early years in which female investigators were a minority in the field and on her participation in the Trailblazers' panel discussion at the Association for Behavioral and Cognitive Therapies on November 29, 2009. Dr. Jarrett writes these reflections in the form of a letter to current and future professionals (of all demographics) dedicated to behavioral science and its practice; she poses questions about what the future may hold.     

Contextual influences on resistance to disruption in children with intellectual disabilities

Training context can influence resistance to disruption under differing reinforcement schedules. With nonhumans, when relatively lean and rich reinforcement schedules are experienced in the context of a multiple schedule, greater resistance is found in the rich than the lean component, as described by behavioral momentum theory. By contrast, when the schedules are experienced in separated blocks of sessions (i.e., as single schedules), resistance is not consistently greater in either component. In the current study, two groups of 6 children with intellectual disabilities responded to stimuli presented in relatively lean or rich components. For both, reinforcers were delivered according to the same variable-interval reinforcement schedule; additionally, the rich component included the delivery of response-independent reinforcers. The Within group was trained on a multiple schedule in which lean and rich components alternated regularly within sessions; the Blocked group was trained on two single schedules in which sessions with either the lean or rich schedule were conducted in successive blocks. Disruption tests presented a concurrently available alternative stimulus disrupter signaling the availability of tangible reinforcers. All 6 Within participants showed greater resistance to disruption in the rich component, consistent with behavioral momentum theory. By contrast, there was no consistent or significant difference in resistance for Blocked participants. This finding is potentially relevant to the development of interventions in applied settings, where such interventions often approximate single schedules and include response-independent reinforcers.     

Some determinants of remote behavioral history effects in humans

Undergraduates were exposed to a series of reinforcement schedules: first, to a fixed-ratio (FR) schedule in the presence of one stimulus and to a differential-reinforcement-of-low-rate (DRL) schedule in the presence of another (multiple FR DRL training), then to a fixed-interval (FI) schedule in the presence of a third stimulus (FI baseline), next to the FI schedule under the stimuli previously correlated with the FR and DRL schedules (multiple FI FI testing), and, finally, to a single session of the multiple FR DRL schedule again (multiple FR DRL testing). Response rates during the multiple FI FI schedule were higher under the former FR stimulus than under the former DRL stimulus. This effect of remote histories was prolonged when either the number of FI-baseline sessions was small or zero, or the time interval between the multiple FR DRL training and the multiple FI FI testing was short. Response rates under these two stimuli converged with continued exposure to the multiple FI FI schedule in most cases, but quickly differentiated when the schedule returned to the multiple FR DRL.     

行为免疫系统对个体就医行为倾向的影响

研究首次考察了行为免疫系统与个体就医行为倾向的关系。3个研究一致显示：行为免疫系统特质性激活水平较高的个体更容易对就医持消极态度和延迟就医; 情境性激活行为免疫系统会使得个体更不愿意就医和更倾向于延迟就医; 且行为免疫系统激活对就医态度和就医延迟倾向的影响以对就医感染风险的感知为中介。这支持了进化失配假说, 提示行为免疫系统对现代医学可能缺乏进化的适应性, 并为理解现代人类就医行为提供了新的理论视角。     

Psychotherapeutic Interventions and Processes

Cognitive behavioral therapy (CBT) has been one of the most influential developments in psychiatry ever. Since it was developed and introduced, a vast number of treatment protocols focused on specific psychiatric syndromes have been developed. Although this has benefitted many patients and advanced the field, CBT as a treatment with its focus on alleviating psychiatric syndromes seemed to have reached a plateau and a process-focus approach is now emerging within the family of CBT models. This represents a new form of idiographic functional analysis guided by models that integrate a coherent set of change processes. Here, I describe the foundations of this new approach to mental health, called process-based therapy (PBT) and discuss its scientific and clinical implications.     

The Gap Between Science and Practice: How Therapists Make Their Clinical Decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists’ practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists’ choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists’ theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.