THE EFFECTS OF REARRANGING WARD ROUTINES ON COMMUNICATION AND EATING BEHAVIORS OF PSYCHOGERIATRIC PATIENTS

Several aspects of ward routine were changed to study the effects of environmental manipulation on the behavior of 21 psychogeriatric patients. Furniture was rearranged to be more conducive to conversation (i.e., grouped around tables instead of along corridor walls), and mealtime routines were changed to allow patients more time to eat, more freedom in choosing the composition of the meal, and more pleasant surroundings. Patients were divided into experimental and control groups, and data were collected on the frequency of verbal and tactile communication and degree of skill in eating behavior. Following baseline, environmental changes were introduced across behaviors. Results show that the frequency of communication increased for the experimental group, as compared to both baseline and the control group. Eating behavior also improved significantly for the experimental group. The study shows that minor changes in the physical environment can promote therapeutic change in the behavior of patients diagnosed as senile dementia.     

PEER-MEDIATED PROCEDURES TO INDUCE SWALLOWING AND FOOD ACCEPTANCE IN YOUNG CHILDREN

Two studies demonstrated a functional relationship between a peer modeling procedure and the treatment of feeding disorders with 2 young children. In the first experiment, the use of a peer model treatment package was shown to induce swallowing in a child with dysphagia who had never swallowed food or liquid. In the second experiment, a child who consistently declined food was induced to increase food acceptance as a function of the same peer modeling package. In the latter experiment, a peer-mediated procedure, consisting of rotated opportunities to consume food with a peer, was found to increase consumption more than did modeling alone. The first experiment used a multiple baseline design across solids and liquids, and the second used a multiple treatment design. The results of both experiments are discussed as new and nonaversive treatments for feeding disorders of young children who are imitative.     

An animal model of excessive eating: schedule-induced hyperphagia in food-satiated rats.

Nineteen rats were maintained throughout the experiment on ad libitum wet mash and water and were trained to press a lever on fixed-interval or fixed-ratio schedules of reinforcement with electrical brain stimulation. Fourteen rats ate at least 150% more mash during intermittent reinforcement sessions than during baseline, massed reinforcement control, and/or extinction sessions. In a 3-hr session, 11 of those 14 consumed more than 22 g of wet mash (13 g dry weight), the equivalent of nearly half an animal's daily food intake. In subsequent control sessions, the electrodes did not support stimulus-bound eating despite attempts to make stimulation parameters optimal. These results indicate that the eating was schedule induced or adjunctive, and suggest that the procedure may provide an animal model of excessive nonregulatory eating that contributes to obesity in humans.     

Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates

This study compared two self-report methods for assessing binge eating in severely obese bariatric surgery candidates. Participants were 249 gastric bypass candidates who completed the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and the Eating Disorder Examination-Questionnaire (EDE-Q) prior to surgery. Participants were classified by binge eating status (i.e., no or recurrent binge eating) with each of the measures. The degree of agreement was examined, as well as the relationship between binge eating and measures of convergent validity. The two measures identified a similar number of patients with recurrent binge eating (i.e., at least 1 binge/week); however, overlap was modest (kappa=.26). Agreement on twice weekly binge eating was poor (kappa=.05). The QEWP-R and EDE-Q both identified clinically meaningful groups of binge eaters. The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity. In addition, the EDE-Q demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern. Using the self-report measures concurrently did not improve identification of binge eating in this study. More work is needed to determine the construct validity and clinical utility of these measures with gastric bypass patients.     

Rapid acquisition in concurrent chains: evidence for a decision model

Pigeons' choice in concurrent chains can adapt to rapidly changing contingencies. Grace, Bragason, and McLean (2003) found that relative initial-link response rate was sensitive to the immediacy ratio in the current session when one of the terminal-link fixed-interval schedules was changed daily according to a pseudorandom binary sequence (e.g., Schofield & Davison, 1997). The present experiment tested whether the degree of variation in delays across sessions had any effect on acquisition rate in Grace et al.'s (2003) rapid-acquisition procedure. In one condition ("minimal variation"), the left terminal link was always fixed-interval 8 s and the right terminal link was either fixed-interval 4 s or fixed-interval 16 s. In the other condition ("maximal variation"), a unique pair of fixed-interval values was used in each session. Responding was sensitive to the current-session immediacy ratio in both conditions, but across subjects there was no systematic difference in sensitivity. These results challenge the view that initial-link responding in the rapid-acquisition procedure is determined by changes in the learned value of the terminal-link stimuli, and suggests instead that a process resembling categorical discrimination may control performance. A decision model based on the assumption that delays are categorized as short or long relative to the history of delays provided a good account of the data and shows promise in being able to explain other choice phenomena.     

Treating Bulimia Nervosa and Achieving Medically Required Weight Loss: A Case Study

Eating disorder and weight loss interventions have typically been regarded as distinct or antithetical, despite a growing number of individuals with comorbid eating pathology and obesity. This siloing of research and practice has created a clinical conundrum for providers seeking to treat individuals with an eating disorder seeking to lose weight (e.g., required pre-surgical weight loss). To date, integrated treatment research targeting both eating disorders and weight loss is rare and practical guidance is lacking, especially for restrictive/binge-purge subtypes. This case example describes how an integrated approach was applied within a naturalistic outpatient clinical practice setting to successfully treat a client presenting with excess weight and severe bulimia nervosa who was medically required to lose weight for orthopedic surgery. We conclude by reviewing the benefits and challenges of integrating eating disorder and behavioral weight loss treatments and providing practical insights for treatment providers.     

Effects of Participant’s Choice of Different Digital Interventions on Outcomes for Binge-Spectrum Eating Disorders: A Pilot Doubly Randomized Preference Trial

It is unclear whether offering individuals a choice between different digital intervention programs affects treatment outcomes. To generate initial insights, we conducted a pilot doubly randomized preference trial to test whether offering individuals with binge-spectrum eating disorder a choice between two digital interventions is causally linked with superior outcomes than random assignment to these interventions. Participants with recurrent binge eating were randomized to either a choice (n = 77) or no-choice (n = 78) group. Those in the choice group could choose one of the two digital programs, while those in the no-choice group were assigned a program at random. The two digital interventions (a broad and a focused program) took 4 weeks to complete, were based on cognitive-behavioral principles and have demonstrated comparable efficacy, but differ in scope, content, and targeted change mechanisms. Most participants (79%) allocated to the choice condition chose the broad program. While both groups experienced improvements in primary (Eating Disorder Examination Questionnaire global scores and number of binge eating episodes over the past month) and secondary outcomes (dietary restraint, body image concerns, etc.), no significant between-group differences were observed. The two groups did not differ on dropout rates, nor on most indices of intervention engagement. Findings provide preliminary insights towards the role of client preferences in digital mental health interventions for eating disorders. Client preferences may not determine outcomes when digital interventions are based on similar underlying principles, although larger trials are needed to confirm this.     

Sharing food with infants in Hadza communities in Tanzania

By analyzing mealtime interactions of Tanzanian Hadza infants with their interactional partners, we explored how two foundational schemas, namely giving/sharing and autonomy are realized and fostered in infants. We focused on three aspects of the mealtime interactions, namely how the infants’ share was protected, whether independent eating was fostered by the infants’ interactional partners, and how infants were encouraged to share food. To answer these questions, we also considered the settings that were created for infant eating, persons involved, and characteristics of the foods. Hadza infants (N = 24) between the ages of approximately 6 and 27 months were video recorded in mealtime situations. The videos were analyzed qualitatively and revealed the following patterns: First, infants’ shares were protected by eating meals in secluded places or providing infants with separate dishes. Second, independent eating was situational. It can be limited according to the child’s interest in the food or by the interactional partner. Some caregivers subtly enhanced independence by appearing unaware of infants’ signals. Third, sharing was encouraged and supported when it occurred spontaneously. Infants were also asked to share and occasionally tricked into sharing. Tolerated scrounging seemed to be generally accepted by both infants and caregivers. However, we also observed conflicts in competitive situations and somewhat overwhelmed infants. These results are discussed in light of hunter-gatherers’ foundational schemas and livelihood changes observed in the Hadza.     

Functional Analysis and Treatment of Mealtime Problem Behavior for a Person with Developmental Disabilities

We conducted a functional analysis of problem behaviors (spitting and whining) during meals and tested an intervention based on that analysis. The participant was a 13-year-old young woman with severe mental retardation and cerebral palsy. She ate all food presented to her, and the hypotheses were tested that the problem behaviors were maintained either by contingent access to trainer attention or the pace of eating. An attention analysis examined the relationship between problem behavior and trainer attention during the meal. The effect of attention following problem behavior versus ignoring was inconclusive. An analysis of the effects of teacher paced eating, student paced eating (reinforce spoon grasping) and food presented for problem behavior was conducted next. Problem behavior rates were highest when access to food was made contingent on the performance of problem behavior and lowest when spoon grasping resulted in a bite of food. Following analysis, an intervention was designed to reduce the frequency of targeted problem behaviors during mealtime. Reinforcing spoon grasping and a 10s removal of food following problem behavior dramatically reduced spitting and whining during meals. The study provides a demonstration of an extended functional analysis and treatment of a complex behavior pattern.     

Rapid facial reactions to emotional facial expressions

This study explored how rapidly emotion specific facial muscle reactions were elicited when subjects were exposed to pictures of angry and happy facial expressions. In three separate experiments, it was found that distinctive facial electromyographic reactions, i.e., greater Zygomaticus major muscle activity in response to happy than to angry stimuli and greater Corrugator supercilii muscle activity in response to angry stimuli, were detectable after only 300–400 ms of exposure. These findings demonstrate that facial reactions are quickly elicited, indicating that expressive emotional reactions can be very rapidly manifested and are perhaps controlled by fast operating facial affect programs.