CLINICAL BEHAVIORAL PHARMACOLOGY: METHODS FOR EVALUATING MEDICATIONS AND CONTINGENCY MANAGEMENT

We evaluated methods for comparing the effects of dextroamphetamine (Dexedrine), thioridazine (Mellaril), and contingency management in the control of severe behavior problems. A reversal design was used in which medications were systematically titrated and assessed in unstructured as well as structured settings with three clients. Subsequently, behavioral procedures including timeout, differential reinforcement of other behavior, and visual screening, were used in a multiple-baseline design across settings. The assessment and design methods were useful in comparing the interventions. Dextroamphetamine decreased inappropriate behaviors and improved academic behaviors in one client, but no reliable effects were observed in the other two clients. Thioridazine was variable across clients, settings, behaviors, and dosages. Contingency management produced consistent decreases in inappropriate behaviors and small improvements in academic performance.     

Concurrent access to two concentrations of orally delivered phencyclidine: effects of feeding conditions.

Two experiments addressed the effects of food satiation and deprivation on oral self-administration of two concurrently available phencyclidine concentrations. In the first experiment, 8 rhesus monkeys self-administered either of two concentrations of phencyclidine ("PCP, angel dust") and water under concurrent fixed-ratio 16 schedules. One concentration was always held constant (0.25 mg/mL) while a series of other phencyclidine concentrations, ranging from 0 (water) to 1.0 mg/mL, was presented in a nonsystematic order. Initially the monkeys were tested while food satiated, and the procedure was then repeated during food deprivation. The monkeys usually selected the higher concentration within the first few minutes of the session, indicating that taste and/or other immediate postingestional effects were important factors. Contrary to a number of previous reports, there were no consistent differences across subjects in the mean number of liquid deliveries or mean drug intake (mg/kg) during food satiation and deprivation. However, for all monkeys the within-session time course of responding during food satiation consistently differed from that during deprivation. A second experiment assessed whether the failure to find consistent differences in drug intake during food satiation and deprivation had been due to the history of concurrent access to different phencyclidine concentrations or to the extended experience with phencyclidine under food-satiation conditions. Six additional monkeys (Group 2) were exposed to the phencyclidine self-administration procedure (during food satiation and deprivation) for the same length of time as the monkeys in Experiment 1 (Group 1), except they received only concurrent access to phencyclidine (0.25 mg/mL) and water. Both groups then received concurrent access to phencyclidine and water during five repeated cycles of food deprivation and satiation. There were also marked individual differences in Group 2: During food satiation, 2 of the monkeys' responding increased, 1 showed no change, and 3 decreased. Examination of a number of historical variables indicated that the greater the percentage of total sessions spent during food satiation with phencyclidine available (before these experiments began), the greater the amounts of phencyclidine consumed during food satiation and the smaller the differences in phencyclidine intake when the two feeding conditions were compared.     

Year of Zoom in a Year of Doom: Lessons Learned Delivering ERP Remotely During the COVID-19 Pandemic

In response to the COVID-19 pandemic and consequential shutdown measures, many mental health professionals started providing therapy to patients exclusively via telehealth. Our research center, which specializes in studying and treating obsessive-compulsive disorder (OCD), historically has provided in-person exposure and response prevention (ERP) to adults with OCD, but shifted to telehealth during the pandemic. Unlike in other modes of talk therapy, ERP’s emphasis on therapist-supervised exposures presented unique opportunities and challenges to delivering treatment entirely via a virtual platform. This paper provides case examples to illustrate lessons we learned delivering ERP exclusively via telehealth in New York from March 2020 through June 2021 and offers recommendations for future study and practice. Though we observed a number of drawbacks to fully remote ERP, we also discovered advantages to delivering ERP this way, meriting additional research attention.     

Video playback,affective witnessing,and the mobility of trauma: Video evidence of violent crime in the criminal justice system

In today's technologically mediated society, video is increasingly relied upon as an objective and reliable source of evidence in the investigation and prosecution of violent crimes. The now pervasive presence of violent video in the criminal justice system, however, presents new challenges for understanding repeated work-related exposure to and witnessing of potentially traumatic material and its impacts. Thus, this project seeks to qualitatively examine the relational affective processes that occur among criminal justice professionals when violent crimes are captured on video. We present four key categories organized around the circumstances of exposure and its impacts: 1) playback in the investigative and pre-trial process; 2) sharing videos among colleagues; 3) playing videos for victims, witnesses, and families and; 4) transmission in the broader public. Findings suggest this work involves deeply embodied processes where video evidence of violent crime enables a virtual presence at scenes and an emotional proximity to events through new forms of witnessing. These affective experiences are one relational dynamic that keeps witnessing active, thus expanding the mobility of trauma, its reach and potential impacts.     

Amniocentesis in sociocultural perspective

This article reports on an anthropological investigation of the social impact and cultural meaning of amniocentesis conducted in New York City, illustrating how class differences, as well as sociocultural diversity, deeply affect pregnant women's acceptance, rejection, and interpretation of prenatal testing. The article also suggests the importance of recognizing how counselors' cultural backgrounds and styles affect patient-counselor communications.     

Unit price as a useful metric in analyzing effects of reinforcer magnitude.

In this paper, we applied the behavioral-economic concept of unit price to the study of reinforcer magnitude in an attempt to provide a consistent account of the effects of reinforcer magnitude on behavior. Recent research in the experimental analysis of behavior and in behavioral pharmacology suggests that reinforcer magnitude interacts with the schedule of reinforcement to determine response rate and total consumption. The utility of the unit-price concept thus stems from its ability to quantify this interaction as a cost-benefit ratio (i.e., unit price = characteristics of the schedule of reinforcement divided by magnitude of reinforcement). Research employing the unit-price concept has shown that as unit price increases, a positively decelerating function exists for consumption (i.e., a function with an increasingly negative slope, when plotted on log coordinates) and a bitonic function exists for response rate. Based on these findings, the present analysis applied the unit-price concept to those studies of reinforcer magnitude and drug self-administration that examined the effects of reinforcer magnitude on response rate using simple schedules of reinforcement (e.g., fixed-ratio schedule). This resulted in three findings: (a) Reinforcer-magnitude manipulations and schedule manipulations interact in a manner that can be quantified in terms of unit price as benefit and cost factors, respectively; (b) different reinforcer-magnitude manipulations are functionally interchangeable as benefit factors in the unit-price ratio; and (c) these conclusions appear warranted despite the differences in reinforcers (food or drug), species (dogs, monkeys, or rats), and schedules (interval or ratio), and despite the fact that these studies were not designed for a unit-price analysis. In methodological terms, these results provide further evidence that employing the unit-price concept is a parsimonious method for examining the effects of reinforcer magnitude. In theoretical terms, these results suggest that a single process may underlie the effect of combined reinforcer-magnitude and schedule manipulations.     

Cognitive sequelae of repeated head injury in a population of intravenous drug users

The relationship between closed head injury and performance on neuropsychological (NP) tests was investigated in a group of intravenous drug users (IVDUs). Subjects with repeated head traumas involving loss of consciousness (LOC) performed worse than both a control group without LOC and reference group with only a single episode of LOC. There were no significant differences between the last two groups. Performance on tests of memory, attention, and motor performance was significantly worse in the group with repeated head injury. The average time since the last episode of LOC was more than 11 years. We conclude from these findings that a single episode of LOC does not result in significant cognitive impairment in this population. Two or more episodes, however, are more likely to produce chronic cognitive impairment.     

Resistance and adherence to the norms of genetic counseling

Genetic counseling for women of advanced maternal age who are considering prenatal testing continues to be based on a principle of nondirectiveness. We interviewed 11 genetic counseling students and four counselors about how they experience and manage, in practice, the tensions between the ideology of nondirectiveness and the acknowledged reality that one can never be truly nondirective. We found that our respondents creatively resolve this tension—simultaneously resisting and adhering to the values of nondirectiveness and information-giving—in individual and situation-specific ways. This resolution is facilitated by the extent to which information given to counselees is fluid, mobile and context-dependent, but these very features of information also have critical implications for both the norms and the practice of genetic counseling.