Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.     

Comparing Traditional and Ebook-Augmented Parent-Child Interaction Therapy (PCIT): A Randomized Control Trial of Pocket PCIT

Disruptive behavior in young children is one of the most common referrals to behavioral health providers. While numerous effective parenting programs, such as parent–child interaction therapy (PCIT), exist for improving children’s behaviors, challenges with treatment engagement and retention limit the intended positive impact on child and caregiver outcomes, particularly for racial and ethnic minority families. In an effort to address barriers contributing to poor engagement and retention in traditional PCIT service delivery and among ethnic and racial minority families, a multimedia PCIT ebook was developed and evaluated. In a sample of the general public that utilized the ebook, users were found to be more engaged in viewing embedded videos within the ebook that were related to expert skill explanations and skill demonstrations than caregiver testimonies. A randomized controlled trial was also conducted to evaluate the extent that the ebook + PCIT improved treatment engagement, retention, parenting skills, skill acquisition efficiency, and child behavior above and beyond traditional PCIT. Participating families were randomly assigned to either the traditional PCIT (n = 71) or ebook + PCIT (n = 107) group using an online random number generator. Forty-nine caregivers (traditional PCIT n = 24, ebook + PCIT n = 25) were excluded from analyses because they were lost to follow-up during the intervention. Families in both the traditional PCIT and ebook + PCIT groups demonstrated generally equivalent positive outcomes in treatment engagement (i.e., attendance, treatment length, completion rate) and caregiver skill acquisition efficiency at midtreatment, posttreatment, and 3-month follow-up. The addition of the ebook to PCIT also reduced child disruptive behavior at midtreatment, above and beyond traditional PCIT, but not at posttreatment or follow-up. Clinical implications and future directions are discussed.     

Treating Childhood Social Anxiety Disorder With Virtual Environments and Serious Games: A Randomized Trial

Disseminating efficacious psychological treatments remains a challenge for researchers and clinicians. In the case of social anxiety disorder (SAD), Social Effectiveness Therapy for Children (SET-C) has been demonstrated as an efficacious intervention, but elements of the protocol, such as peer generalization sessions, remain challenging to conduct in typical clinical settings. To address this need, we developed an artificially intelligent, web-based application, Pegasys-VR™, designed to replace peer generalization sessions and enhance homework compliance. The feasibility of Pegasys-VR™ was tested in a randomized controlled trial in comparison to SET-C. The results indicated that both programs were equally efficacious in decreasing anxiety and improving social skill in social encounters. Sixty-three percent (63%) of children treated with SET-C and 60% treated with Pegasys-VR™ did not meet diagnostic criteria for SAD at posttreatment. Pegasys-VR™ is a feasible, efficacious, and dissemination-friendly element of a comprehensive treatment program for social anxiety disorder in children.     

An update on the search for symmetry in nonhumans

Sidman et al.'s (1982) failure to find evidence for symmetry (bidirectional associations between stimuli) in monkeys and baboons set the stage for decades of work on emergent relations in nonhumans. They attributed the failure to the use of procedures that did not (1) promote stimulus control based on the relation between the sample and correct comparison and (2) reduce control by irrelevant stimulus features. Previous reviews of symmetry in nonhumans indicated that multiple exemplar training and successive matching might encourage appropriate stimulus control. This review examined 16 studies that investigated symmetry in 94 subjects, including pigeons, rats, capuchin monkeys, and baboons. Several studies used alternative training procedures to minimize sources of irrelevant stimulus control, and many combined multiple exemplar training with other procedural modifications. Symmetry was observed in approximately 30% of subjects. Studies that reported the strongest evidence for symmetry used successive matching-to-sample procedures that included training on both symbolic and identity relations, and studies finding mixed evidence employed alternative methods. These studies highlight the challenge in creating training procedures that promote symmetry and the need to assess the underlying sources of control on positive demonstrations.     

Computer‐based training to teach observers to accurately score problem behavior using fast forwarding at 5x normal speed

The current study evaluated whether a computer‐based training program could improve observers' accuracy in scoring discrete instances of problem behavior at 5x normal speed using a multiple‐baseline design across subjects. During pretraining and posttraining, observers attempted to score multiple examples of problem behavior at 5.0x without feedback. During training, participants scored multiple examples of problem behavior at 5.0x with automated feedback. Researchers measured omission (missing problem behavior) and commission (scoring other behavior as problem behavior) errors and the total duration of scoring time to determine the observers' accuracy and efficiency, respectively. After training, all participants scored instances of problem behavior with less than 11% error using 5.0x. The time required to score the videos across 90‐min observations was reduced by 66%. Results extend previous evaluations of fast forwarding by demonstrating that the training program could be used to teach observers to accurately score problem behavior using a speed faster than 3.5x.     

Functional communication training: From efficacy to effectiveness

Functional communication training (FCT; Carr & Durand, 1985) is a common function‐based treatment in which an alternative form of communication is taught to reduce problem behavior. FCT has been shown to result in substantial reductions of a variety of topographically and functionally different types of problem behavior in children and adults (efficacy). The extent to which these reductions maintain in relevant contexts and result in meaningful changes in the lives of those impacted (effectiveness) is the focus of this paper. This review evaluates the degree to which FCT has been established as an evidence‐based practice in psychology (EBPP) according to the definition set out by the American Psychological Association's 2005 Presidential Task Force on Evidence‐Based Practice. Our review finds overwhelming evidence in support of FCT as an efficacious treatment but highlights significant limitations in support of its effectiveness. In order to also be recognized as an EBPP, future research on FCT will need to focus more closely on issues related to home, school, and community application, feasibility, consumer satisfaction, and more general and global changes for the individual.     

COVID-19 and the Acceleration of Behavioral Parent Training Telehealth: Current Status and Future Directions

The SARS-COV-2 (COVID-19) pandemic and associated social distancing guidelines have accelerated the telehealth transition in mental health. For those providing Behavioral Parent Training (BPT), this transition has called for moving sessions that are traditionally clinic-based, active, and directive to engaging, supporting, and treating families of children with behavior disorders remotely in their homes. Whereas many difficulties accompany this transition, the lessons learned during the current public health crisis have the potential to transform BPT service delivery on a large scale in ways that address many of its long-standing limitations. We describe both challenges and opportunities and consider the possibilities inherent in a large scale BPT service delivery model capable of increasing the reach and impact of evidence-based treatment for all families.     

Using the teaching interaction procedure to train interventionists to implement the Cool versus Not CoolTM procedure

The teaching interaction procedure is a behavior analytic procedure that has been used to target the development of social skills. The teaching interaction procedure consists of labeling the target skill, providing a meaningful rationale, describing the steps of the target skill, modeling the skill, role‐play, and providing feedback throughout the interaction. Although the teaching interaction procedure has been used to teach a variety of social skills for individuals diagnosed with autism spectrum disorder (ASD), it has only been used to train staff in two studies. The purpose of this study was to evaluate the use of the teaching interaction procedure to teach three interventionists to implement the Cool versus Not Cool? procedure to target the development of social skills for children diagnosed with ASD. The results of a multiple baseline design demonstrated that the teaching interaction procedure was effective for all three interventionists. Results of the child participants' skill acquisition are also provided.     

Comparing computer‐based training and lecture formats to teach visual analysis of baseline‐treatment graphs

Accurate analysis of data is vital to the validation of interventions. As such, there has been a recent increase in studies evaluating visual analysis training procedures. However, past investigations have not evaluated direct and indirect visual analysis training methods with matched instructional content that was systematically designed. Furthermore, training has rarely included assessment of generalization and maintenance of visual analysis skills. The purpose of the current dissertation study was to compare the effectiveness and efficiency of (a) computer‐based training, (b) lecture formats with and (c) without the opportunity to pause, and (d) a no‐training group to teach visual analysis of AB graphs to university students. To make these formats directly comparable, the instructional content was equated by ensuring information and examples were identical across the three training procedures. Eighty‐three students were randomly assigned to one of the four groups. Results showed that all three training formats produced increases in accurate responding compared to the no‐training group. Visual analysis skills generalized to novel graphs and maintained approximately 2 weeks following all trainings. These results suggest that structured approaches that are carefully designed to train visual analysis are effective and lead to gains that generalize and maintain in the absence of training.     

On-road study investigating the mode of feedback delivery on young drivers’ speed management

Feedback has been shown to be instrumental in learning. Refining how it is delivered in driver training has the potential to reduce crash risk. Therefore, the aim of the present study was to examine the effect of the medium in which feedback is delivered (verbal, written, graphical) on young drivers’ speed management behaviour. Sixty young drivers, randomly allocated to one of four feedback groups (i.e., Control, Verbal feedback, Written feedback, and Graphical feedback) completed one training and two test drives using an instrumented vehicle on-road. After the first (baseline) drive, participants were provided feedback about the number of times they exceeded the speed limit, their maximum speed, as well as the financial penalties associated with such driving behaviour, and safety implications. The content of feedback remained the same for all training groups, except for the manner in which the feedback was presented. Verbal feedback was provided verbally by the researcher; written feedback on paper; and graphical feedback using a series of graphs on a computer screen. Control received no such intervention. Two test drives followed, one immediate post-training, and the second one week post-training. Feedback, irrespective of medium improved young drivers’ speed management. Verbal and graphical feedback yielded the greatest reduction in speeding behaviour, with graphical feedback having the most impact in the two speed zones under examination (50 km/h & 80 km/h). Control showed the poorest speed management behaviour in all drives. These findings have important implications for the development of a new approach to improve young drivers’ speed management behaviour.