The momentum of human behavior in a natural setting

Adults with mental retardation in a group home received popcorn or coffee reinforcers for sorting plastic dinnerware. In Part 1 of the experiment, reinforcers were dispensed according to a variable-interval 60-s schedule for sorting dinnerware of one color and according to a variable-interval 240-s schedule for sorting dinnerware of a different color in successive components of a multiple schedule. Sorting rates were similar in baseline, but when a video program was shown concurrently, sorting of dinnerware was more resistant to distraction when correlated with a higher rate of reinforcement. In Part 2 of the experiment, popcorn or coffee reinforcers were contingent upon sorting both colors of dinnerware according to variable-interval 60-s schedules, but additional reinforcers were given independently of sorting according to a variable-time 30-s schedule during one dinnerware-color component. Baseline sorting rate was lower but resistance to distraction by the video program was greater in the component with additional variable-time reinforcers. These results demonstrate that resistance to distraction depends on the rate of reinforcers obtained in the presence of component stimuli but is independent of baseline response rates and response–reinforcer contingencies. Moreover, these results are similar to those obtained in laboratory studies with pigeons, demonstrating that the determination of resistance to change by stimulus–reinforcer relations is not confined to controlled laboratory settings or unique to the pigeon.     

Treatment-resistant depressed patients show a good response to Mindfulness-based Cognitive Therapy

Mindfulness-based Cognitive Therapy (MBCT) is a class-based programme designed for use in the prevention of relapse of major depression. Its aim is to teach participants to disengage from those cognitive processes that may render them vulnerable to future episodes. These same cognitive processes are also known to maintain depression once established, hence a clinical audit was conducted to explore the use of MBCT in patients who were currently actively depressed, and who had not responded fully to standard treatments. The study showed that it was acceptable to these patients and resulted in an improvement in depression scores (pre-post Effect Size=1.04), with a significant proportion of patients returning to normal or near-normal levels of mood.     

Differences in the effect of Pavlovian contingencies upon behavioral momentum using auditory versus visual stimuli.

We examined the role of Pavlovian and operant relations in behavioral momentum by arranging response-contingent alternative reinforcement in one component of a three-component multiple concurrent schedule with rats. This permitted the simultaneous arranging of different response-reinforcer (operant) and stimulus-reinforcer (Pavlovian) contingencies during three baseline conditions. Auditory or visual stimuli were used as discriminative stimuli within the multiple concurrent schedules. Resistance to change of a target response was assessed during a single session of extinction following each baseline condition. The rate of the target response during baseline varied inversely with the rate of response-contingent reinforcement derived from a concurrent source, regardless of whether the discriminative stimuli were auditory or visual. Resistance to change of the target response, however, did depend on the discriminative-stimulus modality. Resistance to change in the presence of visual stimuli was a positive function of the Pavlovian contingencies, whereas resistance to change was unrelated to either the operant or Pavlovian contingencies when the discriminative stimuli were auditory. Stimulus salience may be a factor in determining the differences in resistance to change across sensory modalities.     

术后镇痛对创伤患者围术期细胞因子和胰岛素抵抗的影响研究

研究术后镇痛对创伤患者围术期细胞因子IL 6、TNFα和胰岛素抵抗（IR）的影响.选取60例患者,随机分为两组,A组患者应用一次性术后镇痛泵,加入舒芬太尼2.5μg/kg＋盐酸托烷司琼4mg,用生理盐水稀释至100ml,2ml/h持续注入.B组患者为术后根据临床需要临时给予杜冷丁每次50mg～100mg肌肉注射,每日不超过3次.发现两组患者术后镇痛效果比较,A组患者舒适程度要优于B组,随访患者无与药物相关的不良反应.术后两组患者血浆IL-6、TNF-α水平均开始升高,术后12h左右达峰值,24h后开始回落,但均明显高于术前.血糖和血胰岛素值也在术后升高,术后24h左右达峰值,之后逐渐回落.ISI在术后开始降低,术后24h降到最低,之后逐渐回升,但均低于术前,说明IL-6、TNF-α水平升高与创伤后胰岛素抵抗有相关性.A组患者术后12h、24h、36h、48h的血糖、血胰岛素、IL-6、TNF-α水平与B组比较明显降低,而且术后48h基本可以恢复术前水平.应用舒芬太尼术后镇痛可以通过抑制血浆中IL-6和TNF-α水平,从而抑制围术期胰岛素抵抗,降低应激反应,从而达到减轻免疫抑制和降低或缩短IR时间的目的.     

肺结核患者的血糖控制

肺结核与糖尿病是两种严重危害人类健康的疾病。越来越多的研究证明,发生结核病的一个重要的危险因素为糖尿病,而且可能会影响肺结核患者的表现和治疗反应。另外,结核病可能会导致糖耐量异常,并使糖尿病患者的血糖控制不良。糖尿病引起肺结核发病增加,可能是因为持续的高血糖损害了针对结核杆菌的机体免疫。对结核病患者合并糖尿病者,药物治疗需考虑到药物动力学,监测血糖,谨慎用药。     

单纯后路手术治疗胸腰椎结核的临床应用

对收治我科的16例胸腰椎结核患者行一期后路病灶清除、植骨融合内固定手术,术后评价结核控制及植骨愈合程度等,并用ASIA分级及评分对神经功能情况进行统计学分析。术后资料示植骨融合、畸形矫正满意,无结核复发。患者感觉和运动功能ASIA评分改善具有统计学意义(P0.05)。因而合理应用本法治疗胸腰椎结核可作为临床骨科医师优先考虑的手术方式。     

细菌耐药性及其防控中的理性思考

细菌对抗菌药物产生耐药性是自然界的普遍规律。抗菌药物的应用和研发与细菌耐药机制的发展互为因果且相互促进,细菌对抗菌药物的耐药性已对感染性疾病的治疗构成严重威胁。理性认识细菌耐药性产生的机制,并在其防控中进行理性思考是提高感染性疾病治愈率的根本所在。     

REINFORCER MAGNITUDE ATTENUATES: APOMORPHINE'S EFFECTS ON OPERANT PECKING

When given to pigeons, the direct‐acting dopamine agonist apomorphine elicits pecking. The response has been likened to foraging pecking because it bears remarkable similarity to foraging behavior, and it is enhanced by food deprivation. On the other hand, other data suggest the response is not related to foraging behavior and may even interfere with food ingestion. Although elicited pecking interferes with food capture, it may selectively alter procurement phases of feeding, which can be isolated in operant preparations. To explore the relation between operant and elicited pecking, we provided pigeons the opportunity to earn different reinforcer magnitudes during experimental sessions. During signaled components, each of 4 pigeons could earn 2‐, 4‐, or 8‐s access to grain for a single peck made at the end of a 5‐min interval. In general, responding increased as a function of reinforcer magnitude. Apomorphine increased pecking for 2 pigeons and decreased pecking for the other 2. In both cases, apomorphine was more potent under the component providing the smallest reinforcer magnitude. Analysis of the pattern of pecking across the interval indicated that behavior lost its temporal organization as dose increased. Because apomorphine‐induced pecking varied inversely with reinforcer magnitude, we conclude that elicited pecks are not functionally related to food procurement. The data are consistent with the literature on behavioral resistance to change and suggest that the effects of apomorphine may be modulated by prevailing stimulus—reinforcer relationships.     

The Tao of Creating Sacred Relationships

SUMMARY

This article articulates the major premises of Sheldon Z. Kramer's book, Transforming the Inner and Outer Family: Humanistic and Spiritual Approaches to the Mind-Body Systems Therapy(The Haworth Press, Inc., 1995). This overview briefly introduces and explains the power of meditation in psychotherapy, meditation and the use of the body, creating congruent communication, working with incongruence in couples and bridging the inner and outer couple.     

The predictive capacity of self-reported motivation vs. early observed motivational language in cognitive behavioural therapy for generalized anxiety disorder

ABSTRACT

Client motivation to change is often considered a key factor in psychotherapy. To date, research on this client construct has largely relied on self-report, which is prone to response bias and ceiling effects. Moreover, self-reported motivation has been inconsistently related to treatment outcome. Early observed client in-session language may be a more valid measure of initial motivation and thus a promising predictor of outcome. The predictive ability of motivational factors has been examined in addiction treatment but has been limited in other populations. Addressing this lack, the present study investigated 85 clients undergoing cognitive behavioural therapy (CBT) alone and CBT infused with motivational interviewing (MI-CBT) for severe generalized anxiety disorder. There were two aims: (1) to compare the predictive capacity of motivational language vs. two self-report measures of motivation on worry reduction and (2) to examine the influence of treatment condition on motivational language. Findings indicated that motivational language explained up to 35% of outcome variance, event 1-year post-treatment. Self-reported motivation did not predict treatment outcome. Moreover, MI-CBT was associated with a significant decrease in the most detrimental type of motivational language compared to CBT alone. These findings support the importance of attending to in-session motivational language in CBT and learning to respond to these markers using motivational interviewing.