Fear conditioning in posttraumatic stress disorder: evidence for delayed extinction of autonomic, experiential, and behavioural responses

Aversive conditioning has been proposed as an important factor involved in the etiology of posttraumatic stress disorder (PTSD). However, it is not yet fully understood exactly which learning mechanisms are characteristic for PTSD. PTSD patients (n=36), and healthy individuals with and without trauma exposure (TE group, n=21; nTE group, n=34), underwent a differential fear conditioning experiment consisting of habituation, acquisition, and extinction phases. An electrical stimulus served as the unconditioned stimulus (US), and two neutral pictures as conditioned stimuli (CS+, paired; CS-, unpaired). Conditioned responses were quantified by skin conductance responses (SCRs), subjective ratings of CS valence and US-expectancy, and a behavioural test. In contrast to the nTE group, PTSD patients showed delayed extinction of SCRs to the CS+. Online ratings of valence and US-expectancy as well as the behavioural test confirmed this pattern. These findings point to a deficit in extinction learning and highlight the role of affective valence appraisals and cognitive biases in PTSD. In addition, there was some evidence that a subgroup of PTSD patients had difficulties in learning the CS-US contingency, thereby providing preliminary evidence of reduced discrimination learning.     

Further examination of factors that influence preference for positive versus negative reinforcement

Factors that influence choice between qualitatively different reinforcers (e.g., a food item or a break from work) are important to consider when arranging treatments for problem behavior. Previous findings indicate that children who engage in problem behavior maintained by escape from demands may choose a food item over the functional reinforcer during treatment (DeLeon, Neidert, Anders, & Rodriguez-Catter, 2001; Lalli et al., 1999). However, a number of variables may influence choice between concurrently available forms of reinforcement. An analogue for treatment situations in which positive reinforcement for compliance is in direct competition with negative reinforcement for problem behavior was used in the current study to evaluate several variables that may influence choice. Participants were 5 children who had been diagnosed with developmental disabilities and who engaged in problem behavior maintained by escape from demands. In the first phase, the effects of task preference and schedule of reinforcement on choice between a 30-s break and a high-preference food item were evaluated. The food item was preferred over the break, regardless of the preference level of the task or the reinforcement schedule, for all but 1 participant. In the second phase, the quality of the break was manipulated by combining escape with toys, attention, or both. Only 1 participant showed preference for the enriched break. In the third phase, choice of a medium- or low-preference food item versus the enriched break was evaluated. Three of 4 participants showed preference for the break over the less preferred food item. Results extend previous research by identifying some of the conditions under which individuals who engage in escape-maintained behavior will prefer a food reinforcer over the functional one.     

A new dynamical model of brainstorming: Linear, nonlinear, continuous (simultaneous) and impulsive (sequential) cases

In this paper, we extended the linear dynamical model of [Brown, V., Paulus, P. B. (1996). A simple dynamic model of social factors in group brainstorming. Small Group Research, 27, 91-114] on two accounts. First, we modelled the sequential type brainstorming using impulsive differential equations by treating each category as an impulse and tested its validity in the two experiments that investigated and demonstrated the beneficial effects of sequential priming and memory in individual brainstorming. Finally, we considered the nonlinear case of brainstorming in writing or brainwriting where dyads exchanged their ideas in a written format and that eliminated negative factors occurring in oral brainstorming (e.g., evaluation apprehension, free-riding, production blocking) and enhanced the upward performance matching, and conducted the second experiment in order to test its validity in this paradigm with the effects of sequential priming and memory. Comparisons showed good agreement between results of experiments and those of the mathematical model.     

The cost effectiveness of cognitive behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

Objective

A number of effective treatments for bulimia nervosa have been developed, but they are infrequently used, in part due to problems with dissemination. The goal of this study was to examine the cost effectiveness of telemedicine delivery of cognitive behavioral therapy for bulimia nervosa.

Method

A randomized controlled trial of face-to-face versus telemedicine cognitive behavioral therapy for bulimia nervosa. One hundred twenty eight women with DSM-IV bulimia nervosa or eating disorder, not otherwise specified subsyndromal variants of bulimia nervosa were randomized to 20 sessions of treatment over 16 weeks. A cost effectiveness analysis from a societal perspective was conducted.

Results

The total cost per recovered (abstinent) subject was $9324.68 for face-to-face CBT, and $7300.40 for telemedicine CBT. The cost differential was accounted for largely by therapist travel costs. Sensitivity analyses examining therapy session costs, gasoline costs and telemedicine connection costs yielded fundamentally similar results.

Discussion

In this study, CBT delivered face-to-face and via telemedicine were similarly effective, and telemedicine delivery cost substantially less. These findings underscore the potential applicability of telemedicine approaches to eating disorder treatment and psychiatric treatment in general.     

USING DIFFERENTIAL REINFORCEMENT TO DECREASE ACADEMIC RESPONSE LATENCIES OF AN ADOLESCENT WITH ACQUIRED BRAIN INJURY

The present study investigated the effects of contingency‐specifying rules and a token economy to decrease the latency to comply with academic instructions by a 16‐year‐old girl with acquired brain injury. Results showed that treatment was successful in reducing academic response latencies. These results replicate previous research in which differential reinforcement was used to decrease slow responding to academic tasks.     

THE EFFECTS OF DIFFERENTIAL REINFORCEMENT OF UNPROMPTED RESPONDING ON THE SKILL ACQUISITION OF CHILDREN WITH AUTISM

The recommendation to reserve the most potent reinforcers for unprompted responses during acquisition programming has little published empirical support for its purported benefits (e.g., rapid acquisition, decreased errors, and decreased prompt dependence). The purpose of the current investigation was to compare the delivery of high‐quality reinforcers exclusively following unprompted responses (differential reinforcement) with the delivery of high‐quality reinforcers following both prompted and unprompted responses (nondifferential reinforcement) on the skill acquisition of 2 children with autism. Results indicated that both were effective teaching procedures, although the differential reinforcement procedure was more reliable in producing skill acquisition. These preliminary findings suggest that the differential reinforcement of unprompted responses may be the most appropriate default approach to teaching children with autism.     

DO CHILDREN PREFER CONTINGENCIES? AN EVALUATION OF THE EFFICACY OF AND PREFERENCE FOR CONTINGENT VERSUS NONCONTINGENT SOCIAL REINFORCEMENT DURING PLAY

Discovering whether children prefer reinforcement via a contingency or independent of their behavior is important considering the ubiquity of these programmed schedules of reinforcement. The current study evaluated the efficacy of and preference for social interaction within differential reinforcement of alternative behavior (DRA) and noncontingent reinforcement (NCR) schedules with typically developing children. Results showed that 7 of the 8 children preferred the DRA schedule; 1 child was indifferent. We also demonstrated a high degree of procedural fidelity, which suggested that preference is influenced by the presence of a contingency under which reinforcement can be obtained. These findings are discussed in terms of (a) the selection of reinforcement schedules in practice, (b) variables that influence children's preferences for contexts, and (c) the selection of experimental control procedures when evaluating the effects of reinforcement.     

AGGRESSION AS POSITIVE REINFORCEMENT IN MICE UNDER VARIOUS RATIO‐ AND TIME‐BASED REINFORCEMENT SCHEDULES

There is evidence suggesting aggression may be a positive reinforcer in many species. However, only a few studies have examined the characteristics of aggression as a positive reinforcer in mice. Four types of reinforcement schedules were examined in the current experiment using male Swiss CFW albino mice in a resident—intruder model of aggression as a positive reinforcer. A nose poke response on an operant conditioning panel was reinforced under fixed‐ratio (FR 8), fixed‐interval (FI 5‐min), progressive ratio (PR 2), or differential reinforcement of low rate behavior reinforcement schedules (DRL 40‐s and DRL 80‐s). In the FR conditions, nose pokes were maintained by aggression and extinguished when the aggression contingency was removed. There were long postreinforcement pauses followed by bursts of responses with short interresponse times (IRTs). In the FI conditions, nose pokes were maintained by aggression, occurred more frequently as the interval elapsed, and extinguished when the contingency was removed. In the PR conditions, nose pokes were maintained by aggression, postreinforcement pauses increased as the ratio requirement increased, and responding was extinguished when the aggression contingency was removed. In the DRL conditions, the nose poke rate decreased, while the proportional distributions of IRTs and postreinforcement pauses shifted toward longer durations as the DRL interval increased. However, most responses occurred before the minimum IRT interval elapsed, suggesting weak temporal control of behavior. Overall, the findings suggest aggression can be a positive reinforcer for nose poke responses in mice on ratio‐ and time‐based reinforcement schedules.     

THE EFFECT OF CHANGES IN CRITERION VALUE ON DIFFERENTIAL REINFORCEMENT OF LOW RATE SCHEDULE PERFORMANCE

The differential reinforcement of low rate (DRL) schedule is commonly used to assess impulsivity, hyperactivity, and the cognitive effects of pharmacological treatments on performance. A DRL schedule requires subjects to wait a certain minimum amount of time between successive responses to receive reinforcement. The DRL criterion value, which specifies the minimum wait time between responses, is often shifted towards increasingly longer values over the course of training. However, the process invoked by shifting DRL values is poorly understood. Experiment 1 compared performance on a DRL 30‐s schedule versus a DRL 15‐s schedule that was later shifted to a DRL 30‐s schedule. Dependent measures assessing interresponse time (IRT) production and reward‐earning efficiency showed significant detrimental effects following a DRL schedule transition in comparison with the performance on a maintained DRL 30‐s schedule. Experiments 2a and 2b assessed the effects of small incremental changes vs. a sudden large shift in the DRL criterion on performance. The incremental changes produced little to no disruption in performance compared to a sudden large shift. The results indicate that the common practice of incrementing the DRL criterion over sessions may be an inefficient means of training stable DRL performance.     

Functional analysis and treatment of self-injury associated with transitions.

We applied functional analysis methodology to the assessment and treatment of 2 individuals' self‐injurious behavior (SIB), which was reported to be occasioned by transitions from one activity or location to another. A structural (task) analysis of activity transitions identified at least three separate components that might influence behavior either alone or in combination: (a) termination of a prechange activity, (b) initiation of a postchange activity, and (c) movement from one location to another. Results of preference and avoidance assessments were used to identify activities to which participants were exposed in varying arrangements during transitions in a functional analysis. Results of 1 participant's functional analysis indicated that his SIB was maintained by avoidance of having to change locations, regardless of the activity terminated prior to the change or the activity initiated following it. The 2nd participant's analysis revealed the same function but also an additional one: avoidance of certain task initiations. This information was used to identify transition contexts during intervention and to design treatment procedures appropriate for a given context and behavioral function. A procedure involving advance notice of an upcoming transition had no effect on SIB, and differential reinforcement of alternative behavior (DRA) had limited effects in the absence of extinction. Sustained decreases in SIB were observed when DRA was combined with extinction and response blocking. Further extensions of functional analysis methodology to the assessment of problem behavior in situations characterized by multiple or protracted stimulus changes are discussed.