Refraining Resistance and Noncompliance in Cognitive Therapy

Despite its general success, not everyone responds to cognitive therapy. Some clients have difficulty complying with assignments and others appear to be frankly resistant. This article considers strategies for dealing with passive noncompliance and active resistance within cognitive therapy. In general, it is argued that the process of therapy is usually facilitated by staying within the cognitive model—that is, by exploring and working through those beliefs and attitudes that underlie noncompliance and resistance in the same manner that other problematic beliefs and attitudes are approached. Also considered are strategies for dealing with unrealistic expectations regarding the pace of change, therapists' errors leading to noncompliance and resistance, and instances in which the therapeutic model is simply insufficient.     

Response-independent milk delivery enhances persistence of pellet-reinforced lever pressing by rats

If, during training, one stimulus is correlated with a higher rate of reinforcement than another, responding will be more resistant to extinction in the presence of that higher rate signal, even if many of the reinforcers have been presented independently of responding. For the present study we asked if the response-independent reinforcers must be the same as the response-dependent reinforcers to enhance the response's persistence. Twelve Long-Evans hooded rats obtained 45-mg food pellets by lever pressing (variable-interval 100-s schedules) in the presence of two discriminative stimuli (blinking vs. steady lights) that alternated every minute during daily sessions. Also, in the presence of one of the stimuli (counterbalanced across rats), the rats received additional response-independent deliveries of sweetened condensed milk (a variable-time schedule). Extinction sessions were exactly like training sessions except that neither pellets nor milk were presented. Lever pressing was more resistant to extinction in the presence of the milk-correlated stimulus when (a) the size of the milk deliveries during training (under a variable-time 30 s schedule) was 0.04 ml (vs. 0.01 ml) and (b) 120-s or 240-s blackouts separated components. Response-independent reinforcers do not have to be the same as the response-dependent reinforcers to enhance persistence.     

从2型糖尿病的发病机制谈糖尿病治疗的新策略

2型糖尿病的发病机制主要为胰岛素抵抗与胰岛β细胞分泌功能受损,二者相互依存、相互作用。2型糖尿病的治疗应以减轻胰岛素的抵抗和保护胰岛β细胞为主,以生活方式干预加二甲双胍作为基础治疗,根据不同个体在不同阶段所侧重的不同发病机制,采用联合、综合管理。     

Article for “Diversity Stories in Community Research and Action” Facing Resistance in Waking Up to Privilege

In 1994, out of a population of 45 million people an estimated 7.7 million people lived in informal settlements in South Africa (South African Institute of Race Relations, 1994). This article focuses on one community whose residents' desperation to own housing contributed to community disintegration, typified by infighting among women, and threats to human life. Issues of diversity became more prominent and destabilized community-building efforts. One effort to collaboratively break down barriers that deterred women from working together is presented to illustrate how these women created bonds based on "discovered similarities." The participatory and personal-experience approach described here contributed to their becoming active protagonists of their learning and encouraged tolerance and understanding among community women from differing ethnic, linguistic, and political backgrounds. The article concludes with a discussion of the critical importance of recognizing and working with and through differences within the current South African reality.     

Fifty years on: a training for the 21 century, from couple to community

The paper describes the gradual transformation of the structures, process and content of the adult training at the Society of Analytical Psychology (SAP) from 1997 when the potential for individuation had gone awry through lack of a culturally relevant and coherent programme until 2005 when trainees' professional and personal individuation could be enhanced by a process and a curriculum representing fairly the interests and beliefs of the range of different approaches to Jungian psychology that are to be found in the SAP. The process has taken eight years to complete and in the paper, the authors, two successive Directors of Training, describe the persistent resistances to necessary change from within their Society, focusing in particular on the key role of the founder member; the privileging of the internal world at the expense of significant external factors; a confusion of roles among members between volunteers and professionals and last, but by no means least, the contamination of the educative task and the creation of a training community by fantasies of the mother/infant couple.     

RESPONDING MAINTAINED BY INTERMITTENT REINFORCEMENT: IMPLICATIONS FOR THE USE OF EXTINCTION WITH PROBLEM BEHAVIOR IN CLINICAL SETTINGS

Results of basic research have demonstrated that behavior maintained on an intermittent schedule of reinforcement (INT) will be extinguished more slowly than behavior maintained on a continuous schedule (CRF). Although these findings suggest that problem behaviors may be difficult to treat with extinction if they have been maintained on INT rather than on CRF schedules, few applied studies have examined this phenomenon with human behavior in clinical settings. The purpose of this study was to determine whether problem behavior maintained on CRF schedules would be extinguished more rapidly than behavior maintained on INT schedules. Three individuals diagnosed with profound mental retardation participated after results of pretreatment functional analyses had identified the sources of reinforcement that were maintaining their self-injury, aggression, or disruption. Subjects were exposed to extinction following baseline conditions with CRF or INT schedules alternated within reversal or multielement designs. Results suggested that problem behaviors may not be more difficult to treat with extinction if they have been maintained on INT rather than CRF schedules. However, switching from an INT to a CRF schedule prior to extinction may lower the baseline response rate as well as the total number of responses exhibited during extinction.     

The momentum of compliance

Compliance with demanding requests that are normally ineffective may be increased by presenting a series of easy or high-probability (high-p) requests before the more demanding requests. Mace and his colleagues have discussed the effectiveness of the high-p procedure in relation to behavioral momentum—the tendency for behavior, once initiated and reinforced, to persist in the face of a challenge. The high-p procedure differs in several ways from that employed in laboratory research on momentum, and the methods and findings of basic research may not be relevant to applied work on compliance. This article reviews some laboratory procedures used in research on behavioral momentum, summarizes the major findings of that research, and discusses its relevance to the high-p procedure and its outcomes. Increased compliance with demanding requests following the high-p procedure can be understood in relation to the procedures and findings of basic research, but some questions arise in the process of translating research into application via the metaphor of momentum. These questions suggest some new directions for both experimental and applied behavior analysis.     

Response-independent food delivery and behavioral resistance to change

Response-independent food was delivered during a dark-key phase between two multiple-schedule components to explore its disruptive effects on responding. Responding in components was maintained by separate variable-interval 120-s schedules, with a 2-s reinforcer in Component 1 and a 6-s reinforcer in Component 2. Across conditions the rate and duration of response-independent food presentations were manipulated. The results showed that response rates in both components decreased as a function of the duration and the rate of response-independent food presentations; moreover, the decrease in response rate relative to the baseline level was larger in Component 1 than in Component 2. These findings were consistent with expectations from behavioral momentum theory, which predicts that if equal disruption (response-independent food in this case) is applied to responding in two components, then the ratio of response-rate change in Component 1 versus Component 2 should remain constant, irrespective of the magnitude of that disruption.     

ALTERNATIVE REINFORCEMENT INCREASES RESISTANCE TO CHANGE: PAVLOVIAN OR OPERANT CONTINGENCIES?

Two multiple-schedule experiments with pigeons examined the effect of adding food reinforcement from an alternative source on the resistance of the reinforced response (target response) to the decremental effects of satiation and extinction. In Experiment 1, key pecks were reinforced by food in two components according to variable-interval schedules and, in some conditions, food was delivered according to variable-time schedules in one of the components. The rate of key pecking in a component was negatively related to the proportion of reinforcers from the alternative (variable-time) source. Resistance to satiation and extinction, in contrast, was positively related to the overall rate of reinforcement in the component. Experiment 2 was conceptually similar except that the alternative reinforcers were contingent on a specific concurrent response. Again, the rate of the target response varied as a function of its relative reinforcement, but its resistance to satiation and extinction varied directly with the overall rate of reinforcement in the component stimulus regardless of its relative reinforcement. Together the results of the two experiments suggest that the relative reinforcement of a response (the operant contingency) determines its rate, whereas the stimulus-reinforcement contingency (a Pavlovian contingency) determines its resistance to change.     

Tests of behavior momentum in simple and multiple schedules with rats and pigeons.

Four experiments examined the relationship between rate of reinforcement and resistance to change in rats' and pigeons' responses under simple and multiple schedules of reinforcement. In Experiment 1, 28 rats responded under either simple fixed-ratio, variable-ratio, fixed-interval, or variable-interval schedules; in Experiment 2, 3 pigeons responded under simple fixed-ratio schedules. Under each schedule, rate of reinforcement varied across four successive conditions. In Experiment 3, 14 rats responded under either a multiple fixed-ratio schedule or a multiple fixed-interval schedule, each with two components that differed in rate of reinforcement. In Experiment 4, 7 pigeons responded under either a multiple fixed-ratio or a multiple fixed-interval schedule, each with three components that also differed in rate of reinforcement. Under each condition of each experiment, resistance to change was studied by measuring schedule-controlled performance under conditions with prefeeding, response-independent food during the schedule or during timeouts that separated components of the multiple schedules, and by measuring behavior under extinction. There were no consistent differences between rats and pigeons. There was no direct relationship between rates of reinforcement and resistance to change when rates of reinforcement varied across successive conditions in the simple schedules. By comparison, in the multiple schedules there was a direct relationship between rates of reinforcement and resistance to change during most tests of resistance to change. The major exception was delivering response-independent food during the schedule; this disrupted responding, but there was no direct relationship between rates of reinforcement and resistance to change in simple- or multiple-schedule contexts. The data suggest that rate of reinforcement determines resistance to change in multiple schedules, but that this relationship does not hold under simple schedules.