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| #473 Poster Session (CBM) |
| Monday, May 26, 2008 |
| 6:00 PM–7:30 PM |
| South Exhibit Hall |
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| 48. Parent and Child Exact Agreement and How it Relates to Diabetes Treatment Adherence. |
| Area: CBM; Domain: Service Delivery |
| BLAKE M. LANCASTER (Munroe-Meyer Institute, University of Nebraska Medical Center) |
| Abstract: Medical regimen adherence significantly influences the patient’s health and impacts the health care providers’ ability to treat any disease or medical problem (Allen & Warzak, 2000). Adherence levels are particularly low in the pediatric population among young patients with diabetes (Anderson, Ho, Brackett, Finkeistein, & Laffel, 1997; Jacobson, et al., 1990; Lask, 1994). In the current investigation, data were collected from over 100 diabetic parent-child dyads (children ages 7-18). During their regular clinic visit, parents and children completed the Diabetes Family Responsibility Questionnaire (DFRQ) independently in separate rooms to determine the degree to which parents and children agreed on who was responsible for the various aspects of daily treatment adherence. A measure of Glycohemoglobin (HbA1c) was also obtained by drawing blood samples at the time of the visit to determine the patient’s glycemic control, or levels of treatment adherence. Exact agreement regarding daily treatment responsibilities was then compared to levels of treatment adherence for both individuals and as a group. Results of this investigation suggest that exact agreement between parents and their children regarding who is primarily responsible for completing treatment tasks on a daily basis may be a significant predictor of adherence levels measured using HbA1c levels. |
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| 49. Exploring the Use of Visual Prompts to Assist with Orientation Following Traumatic Brain Injury. |
| Area: CBM; Domain: Applied Research |
| CHRISTINA M. PETERS (ReMeD Rehabilitation) |
| Abstract: This project explores the efficacy of use of visual prompting systems to help increase orientation for clients who have sustained traumatic brain injury. Systems explored include various scheduling systems, visual cues (environmentally embedded and more overt) and the use of visual timers. |
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| 50. A Behavioral Interpretation of Factitious Disorder. |
| Area: CBM; Domain: Applied Research |
| SEAN M. CORIATY (Lakeview NeuroRehabilitation Center), Tina M. Trudel (Lakeview NeuroRehabilitation Center) |
| Abstract: Factitious Disorder (FD), also known as Hospital Addiction Syndrome or Munchausen Syndrome, is defined as a diagnosis by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV). FD is diagnosed if the following criteria are met: (a) intentionally producing or feigning physical or psychological symptoms; (b) motivation for the behavior is to assume the sick role; (c) external incentives for the behavior (e.g., avoiding work) are absent. The psychological literature informs that the diagnosis is relatively rare, the condition is chronic, treatment is difficult, and prognosis is poor; there exist no documented successful treatment attempts. The current study re-frames the diagnosis in behavioral terms, provides data derived from a case study of an 18-year-old female diagnosed with FD, documents behavior analytic treatment attempts, and discusses relevant case history. The potential treatment benefit of re-framing the disorder in behavior analytic terms is discussed. |
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| 51. Adherence to Exercise Regimen in Response to Behavioral Contracting and Public Posting. |
| Area: CBM; Domain: Applied Research |
| ALBERT MALKIN (The Chicago School of Professional Psychology), John P. Smagner (University of Chicago), Diana J. Walker (The Chicago School of Professional Psychology) |
| Abstract: Exercise is a healthy behavior that can decrease weight and the occurrence of some illnesses. The purpose of this ongoing study is to increase exercise behavior of adults through goal-setting, self-monitoring, a behavioral contract, and/or public display of exercise data. Participants set exercise goals, and baseline consists of gym records of participants' attendance prior to intervention. During the first intervention phase (self-monitoring), participants self-report on their gym attendance. Gym records serve to corroborate self-reports in this and subsequent phases. The second phase starts if goals are not met; this involves a behavioral contract, requiring a deposit, part of which is refunded weekly if goals are met. If exercise goals are met for 4 consecutive weeks, there is a $50 reward plus the remaining deposit. Public posting begins if goals are not met for two consecutive weeks. If participants do not meet exercise goals and money is left over, it is donated to a cause, organization, or institution that participants are "morally opposed to." There is a one-month follow up. Preliminary results show that one participant met his goals during the self-monitoring phase, but this was not maintained at follow-up. Data will be presented on other participants, as well. |
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| 52. Bowel and Bladder Regimen Adherence for Young Adults with Spina Bifida. |
| Area: CBM; Domain: Applied Research |
| BRIDGET G. GIBBONS (Kennedy Krieger Institute), Adrianna M. Amari (Kennedy Krieger Institute), Melissa A. Meyers (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute/Johns Hopkins University) |
| Abstract: The majority of children and adults with Spina Bifida utilize clean intermittent catheterization (CIC) and/or enemas and suppositories to maintain bowel and bladder continence. However, people with Spina Bifida may have cognitive deficits impacting attention, problem-solving, memory, and organization, which can negatively impact adherence to a bowel and bladder regimen. In this study, a treatment package designed to increase adherence with bowel and bladder program was implemented with three young adults with Spina Bifida. Treatment consisted of the implementation of a daily schedule and self-monitoring logs, an electronic medication reminder which served as both an auditory and visual prompt, and positive reinforcement for following a daily bowel and bladder routine. All 3 participants increased their adherence to their bowel and bladder regimens following treatment. Maintenance of treatment gains and follow-up data will be presented. |
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| 54. Toward More Precise Prediction and Control of Health Behavior: A Functional Analysis of Emotion in Cardiac Rehabilitation. |
| Area: CBM; Domain: Applied Research |
| PAULETTE J. CHRISTOPHER (University of New Mexico), Michael J. Dougher (University of New Mexico), Laura Bouldin (University of New Mexico), Bruce Smith (University of New Mexico) |
| Abstract: The role of emotional responding in complex behavior is important yet often ignored by behavior analysts (Dougher & Hackbert, 2000). While many studies examine the occurrence of anxiety, depression, and emotion after cardiac events (Frazure-Smith et al., 1995) and their relation to cardiac rehabilitation (Guiry et al, 1987), few examine the effects of emotion at non-pathological levels. To our knowledge, none describe emotion functionally as the effects of relevant establishing operations or as factors that occasion behavior that may interfere with rehabilitation. The present study aims to better predict outcomes in cardiac rehabilitation by differentiating between depression and anxiety, examining the role of non-pathological levels of emotion, and offering a behavior analytic account of the relation between emotion and health behavior. Seventy-five patients enrolled in a 12-week cardiac rehabilitation program will be assessed for positive and negative emotion (Emotion Scale; Larsen & Diener, 1992) depression and anxiety (Hospital Anxiety and Depression Scale; Zigmond, & Snaith, 1983) diet and exercise behavior (Block et al., 2000) and adherence. Increasing the precision of assessing emotional effects on cardiac outcomes and explaining these effects from a BA perspective could allow for greater prediction and control of health behavior. |
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| 55. A Fear Reduction Intervention on Behaviorally Limited Functional Movements for Patients with Chronic Back Pain. |
| Area: CBM; Domain: Applied Research |
| ANDREW H. HAWKINS (West Virginia University), Alan Nasypany (University of Idaho) |
| Abstract: Patients with chronic pain syndrome often present with kinesiophobia, a fear of movement which constrains functional movement beyond limitations imposed by any particular pathology. In this study, graded exposure, a fear reduction intervention, was applied to kinesiophobic patients with chronic low back pain (CLBP) in an attempt to increase functional movements. Three subjects (1 female, 2 males; ages 32-50) with CLBP were enrolled in a multi-disciplinary functional restoration physical therapy program. Graded exposure was a brief explanation to patients of the “fear avoidance” model of kinesiophobia, after which they were encouraged to exercise in spite of pain since no further damage would result. This model was presented following stable baselines, and patients were occasionally reminded of the model throughout the intervention. Target behaviors included two movement tasks (1) repeated forward flexion and 2) sit to stand and walk) both of which were measured by repetitions in one minute. Two multiple baseline designs were used to assess effectiveness: 1) across participants within movement tasks, and 2) across movement tasks within each participant. Visual inspection yielded unequivocal demonstrations of effectiveness in all three participants for both target behaviors. The use of simple verbal interventions in movement therapy settings is discussed. |
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| 56. Treatment of Childhood Obesity: An Opportunity for Behavior Analysts. |
| Area: CBM; Domain: Applied Research |
| NICOLE M. SWEENEY (Kennedy Krieger Institute), Sung Woo Kahng (Kennedy Krieger Institute), Nicole Lynn Hausman (Kennedy Krieger Institute), Alyssa Fisher (University of Maryland, Baltimore County), Teresa Troiano (University of Maryland, Baltimore County) |
| Abstract: It is reported that that approximately 15% of all children and adolescents in the U.S. are overweight or obese. Childhood obesity most likely results from an interaction of nutritional, environmental, and physiological factors. The risk of becoming obese is greatest among children who have two obese parents (Dietz, 1983). This may be due to parental modeling of both eating and exercise behaviors, indirectly affecting the child's energy balance. Previous research has suggested that the use of family-based, behavioral weight management programs may be an effective intervention for children who are overweight or obese (Epstein, Wing, Koeske, Andrasik, & Ossip, 1981). These family-based interventions are also effective in promoting long-term maintenance of weight loss (Epstein, Valoski, Wing, & McCurley, 1985). The current investigation examined the effects of a behavioral family-based treatment on the percent overweight of obese children and their parents. Several behavioral procedures including contracting, self-monitoring, and modeling were utilized to increase the consumption of healthy foods and increase overall physical activity. Findings replicate previous studies that show that family-based, behavioral weight management programs are an effective intervention to treat childhood obesity. |
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| 57. CB Ferster and Bad Feelings: Functional Analytic Models of Depression Among Prostate Cancer Patients. |
| Area: CBM; Domain: Applied Research |
| CHRISTOPHER F. SHARPLEY (University of New England), Vicki Bitsika (Bond University), David Harry Christie (East Coast Cancer Centre) |
| Abstract: The incidence of depression is rising in the western world and applied behaviour analysis offers effective ways of understanding and treating this disorder. Ferster and others have described depression as an adaptive response to the presence of noxious environmental events and/or the withdrawal of previously-available social reinforcers. To test this model among a specific sample with health-related depressive behaviour, data from 195 prostate cancer patients’ responses to a standardised depression inventory were factor analysed. Four major factors were revealed. These were: (1) loss of functional capacity, sense of worthlessness and hopelessness; (2) fear plus sympathetic nervous system activation; and (3, 4) somatic symptomatology across two aspects of autonomic nervous system activation. There are also data that indicate that these patients had developed self-maintaining behaviours that in turn acted as antecedents for further unpleasant environmental events and removal of valued interactions with others. These data provide support for a Functional Analytic model of depression among this population that may be applied to other groups and which argue in favour of ABA approaches for treatment of depression. |
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| 58. Toward Increasing the Cost-Effectiveness of Contingency Management: Using Percentile Schedules and Escalating Quality of Reinforcement in an Intervention Designed to Reduce Smoking in College Students |
| Area: CBM; Domain: Applied Research |
| BRANTLEY P. JARVIS (James Madison University), J. Philip Erb (James Madison University), Kristin A. Kiel (James Madison University), Jessica Greta Marie Irons (James Madison University), Sherry L. Serdikoff (James Madison University) |
| Abstract: The present study addresses the feasibility of implementing a contingency management program to reduce cigarette smoking in college students. Participants enrolled in a 4-week ABA design study. During baseline weeks, participants are paid contingent upon attending at data collection sessions. During treatment weeks, participants are paid contingent on a criterion level of reduced smoking as set according to a percentile schedule. Reinforcers are gift certificates and other items donated from the community that each participant rank-ordered in a preference assessment during the first data collection session. All reinforcers are equal in monetary value and delivered in an escalating order from least to most preferred contingent upon successive reductions in smoking. These data will provide information on the effectiveness of manipulating quality of reinforcement rather than magnitude of reinforcement within the context of a contingency management intervention, as a mechanism for reducing cost and provide further evidence on contingency management as an appropriate treatment for reducing cigarette smoking in a college population. |
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| 59. The Function of Behavior Analysis in Health Psychology: Cross-Citations and JABA Publication Analyses. |
| Area: CBM; Domain: Applied Research |
| ALEK JOSEPH REED (University of Illinois, Urbana-Champaign), Derek D. Reed (Syracuse University), Florence D. DiGennaro Reed (Melmark New England), Travis Cos (Drexel University), Rita M. Gardner (Melmark New England) |
| Abstract: Applied behavior analysis is a subfield within psychology that approaches behavior change through operant techniques based upon the experimental analysis of behavior. Since the inception of this discipline, behavior analysts have been interested in the treatment of health concerns through the use of behavioral techniques based upon the principle of reinforcement. This poster highlights an analysis of the publication trends of treatment studies related to health psychology in the Journal of Applied Behavior Analysis between the years of 1968 and 2006. A total of 81 treatment studies met inclusionary criteria and were coded on variables concerning demographic information and treatment methodology. A supplementary analysis of cross-citation relationships between top behavior analysis and health psychology journals were conducted using the 2004–2006 Journal Citation Reports® database. Results of these bibliometric examinations revealed limited citations between health psychology and behavior analysis. A summary of all analyses and a discussion of how behavior analysts can improve in their study of health psychology treatments will be provided. |
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| 60. HSF: A Case Study: Smoking Cessation, Increasing Physical Activity (Exercise), and Weight Loss Reduction. |
| Area: CBM; Domain: Applied Research |
| VICTORIA FOGEL (University of South Florida) |
| Abstract: The participant in this study was a 44-year-old woman who smoked an average of 18 cigarettes per day, engaged in zero minutes of physical activity (exercise) per day, and was overweight. This study utilized self-recording, goal-setting, positive reinforcement (money was contingent on meeting daily goal and engaging in replacement behaviors), and TAGteaching (using an acoustical sound [conditioned reinforcer] to mark replacement behaviors immediately as they occur) to decrease smoking behavior, increase physical activity, and reduce calorie intake. Results show that smoking decreased to zero and the results were maintained over time; physical activity increased from 0 minutes per week to an average of 300 minutes per week, and the client lost a total of 23 inches (bust, arms, waist, hips, and thigh measurements combined). Ongoing data are being collected as well as IOA. Limitations to this study are that indirect measures (self-reporting) have been used as the primary means of data collection (client is out-of-state), IOA did not occur for the smoking procedure, and client is a family member (dual-role relationship). Poster will address when it may be appropriate to work with a family member and propose best practices for working in a dual-role relationship. |
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