|
| #185 Poster Session – CBM |
| Sunday, May 29, 2005 |
| 12:00 PM–1:30 PM |
| Southwest Exhibit Hall (Lower Level) |
|
| 46. Effect of Behavioral Activation Treatment on Pain Anxiety Cognition |
| Area: CBM; Domain: Applied Research |
| DUANE A. LUNDERVOLD (Central Missouri State University), Christopher J. Talley (Central Missouri State University), Michael Buermann (Central Missouri State University) |
| Abstract: Effects of Behavioral Activation Treatment on pain anxiety and depression of a 43-year-old female with an 11-year history of chronic pain are described. DSM-IV-TR diagnoses were major depression, social anxiety, anxiety due to a medical condition, and pain disorder. Medical diagnoses were fibromyalgia, traumatic migraine and irritable bowel syndrome. Analgesic, anxiolytic, and antidepressant medications were stabilized prior to participation. Geriatric Depression Scale-15, pain interference rating, Pain Anxiety Symptom Scale and Behavioral Relaxation Scale were used to assess outcome. A within session repeated pre-post training assessment embedded in a multiple baseline across relaxed positions single-subject experimental design was used. Behavioral relaxation training resulted in an immediate increase in percentage of reclined relaxed behaviors with response generalization to upright relaxed position observed. A 100% change from baseline pain interference ratings was obtained following BAT. All four dimensions of pain anxiety declined to normative levels following BAT intervention. Pain anxiety cognition declined without direct intervention. Depression declined to normative levels. Results of BAT on pain anxiety cognition are consistent with effects obtained with depressed populations. BAT was sufficient to support change in healthy overt behavior and pain anxiety cognition. Further research on BAT and pain anxiety cognition is needed with chronic pain patients with fibromyalgia. |
| |
|
| 47. Two and a Half Years Follow-Up of Weight and Body Mass Index Values in the Weight Control for Life! Program: A Descriptive Analysis |
| Area: CBM; Domain: Applied Research |
| BLAKE NUNN (University of Wisconsin-Milwaukee), R. Gregory Nunn (National University) |
| Abstract: This descriptive study monitored weight, Body Mass Index, and percent excess weight changes in 60 clients, (44 females, 16 males) at about 1 year and 2.5 years following participation in the Weight Control for Life! Program. The Program integrates the habit reversal treatment model with contingency management and operant reinforcement principles; nutrition education; physical activity; stress management; cognitive-restructuring; relapse prevention; social support; intensive, on-going maintenance; self-monitoring; and the use of a medically supervised very-low-calorie diet or low-calorie-diet. Clients' pretreatment and posttreatment weights averaged 104.28 kg (229.42 lb) and 79.89 kg (175.76 lb) respectively, representing a 68% reduction in excess body weight at the end of the weight loss phase of the Program. Mean weight loss at about 1 year and 2.5 years post weight loss was 19.28 kg (42.42 lb) and 13.09 kg (28.80 lb), indicating subjects maintained 75% and 52% of their weight losses at these two time periods. Men lost more weight and maintained better losses than women. Overall, there was a 41% reduction in excess body weight at the end of 2.5 years. |
| |
|
| 48. Parental Nonadherence to Treatment Recommendations After Discharge from a Feeding Program: Functional Assessment and Intervention |
| Area: CBM; Domain: Applied Research |
| JOYCE KAO (Kennedy Krieger Institute), Kellie Hilker (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute) |
| Abstract: Little attention has been given to the area of determining the contingencies that affect parental adherence to behavioral protocols. Parents may not follow the protocol if his or her efforts have been punished for implementing the protocol. Social disapproval toward the recommended behavior-change procedures may also affect the way parents manage their children. Lack of generalizations across settings and response effort resulting from a complex protocol can lead to problems implementing the protocol. Conducting a functional assessment to determine why the parents are not adhering to the behavioral recommendations can help to improve implementation of the protocol beyond the clinic environment. In this study, an intervention was implemented to help parents adhere to the protocol based on the maintaining contingencies identified through a functional assessment of parent behavior. Parent integrity measures were collected at discharge as baseline. Integrity measures from the first follow-up were compared to the second follow-up to determine whether the parents’ changed their behavior after the intervention and whether it impacted the child’s eating behavior. Implications of parent training methodology will be discussed. |
| |
|
| 49. Acceptance, Bariatric Surgery, and Comorbid Conditions |
| Area: CBM; Domain: Service Delivery |
| DANIEL J. MORAN (MidAmerican Psychological Institute), Patricia Bach (Illinois Institute of Technology) |
| Abstract: Approximately 97 million U.S. adults are overweight or obese (Kuczmarski, 1997).This condition is estimated to affect over 50% of the adult population, and is comorbid with several serious diseases. Obese individuals (with a Body Mass Index >40) also differ from the normal weight population by having higher depression and anxiety ratings, and a lower quality of life (Holtzclaw, 2003). Bariatric surgery reduces the size of the stomach and limits food consumption to less than 50 mL. This surgery influences the improvement of eating behavior and reduces caloric intake. According to the guidelines of the American Society for Bariatric Surgery, a “multi-disciplinary referral system is required… and psychological assistance is needed” for the procedure. Clinical behavior analysts can screen for psychopathology, substance abuse, and eating disorders, and also assess the client’s ability to follow the post-surgery regimen. Post-surgery clients benefit from applied behavior analysis to maintain the post-surgery regimen, and from therapeutic interventions to address socio-emotional changes concomitant with drastic weight loss. Acceptance & Commitment Therapy treatment protocols may impact post-surgery adjustment.The correlation between the Acceptance and Action Questionnaire-2, BDI-2, quality of life measures and Body Mass Index is discussed, and pilot data is exposed regarding weight loss outcome. |
| |
|
| 50. Pedometers and Brief Family Physician Counseling: Increasing Physical Activity for Patients |
| Area: CBM; Domain: Applied Research |
| JEFFREY VANWORMER (HealthPartners Center for Health Promotion), Steven Stovitz (University of Minnesota), Bruce Center (University of Minnesota), Karin Lindstrom Bremer (University of Minnesota) |
| Abstract: Due to their frequent encounters with sedentary patients, family physicians are poised to be on the forefront of the medical community’s response to physical inactivity. The purpose of this study was to examine whether the addition of a pedometer and activity self-monitoring log to brief physician counseling could help patients increase their lifestyle physical activity. Ninety-four participants recruited from a family practice clinic were randomly assigned to two groups. Both groups received a brief physician endorsement of regular physical activity, a handout on the benefits of an active lifestyle, and three follow-up phone calls from a health educator. In addition, the intervention group received a pedometer and was instructed to record their steps daily over the nine-week study period. Measurements were taken for self-reported walking and pedometer steps (intervention group only). Both groups significantly increased self-reported blocks walked per day, stairs would climb versus using the elevator, days per week walking 30 minutes or more, and walking for fun/leisure. Among study completers, those in the pedometer group increased their average daily steps by 41% over the nine weeks. Additionally, the frequency of walking short trips improved significantly more in the pedometer group relative to the comparison group. The results encourage further study of using pedometers in the context of physician-based physical activity counseling. |
| |
|
| 51. An Integrative Behavior Therapy for Smoking Cessation |
| Area: CBM; Domain: Service Delivery |
| JAMES ANDERSON (Western Michigan University), Scott T. Gaynor (Western Michigan University) |
| Abstract: Smoking is a serious health problem worldwide. Several intervention techniques to help people quit have demonstrated some measure of success, though none has clearly distinguished itself as a superior intervention. Nicotine transdermal systems have become increasingly popular and have demonstrated some success, but relapse rates remain alarmingly high. Psychology has offered some promising intervention techniques, yet none has produced consistent data of sustained abstinence. Motivational Interviewing (MI), exposure therapy, Acceptance and Commitment Therapy (ACT), and contingency management have all demonstrated promise in assisting smokers to achieve abstinence. In this study, we will combine aspects of all of these treatment techniques. The protocol includes one session of MI (in order to assess and facilitate desire and commitment to change), six sessions of ACT-enhanced exposure therapy with concurrent scheduled smoking reduction (to help the patient learn to tolerate withdrawal symptoms while accepting their inevitability and maintaining his or her commitment to abstinence), and a week of contingency management (in order to help patients achieve an initial period of total abstinence that previous research has indicated is a good predictor of longer-term success in maintaining abstinence). The poster will provide a detailed rationale for the present protocol as well as available data. |
| |
|
| 52. The Impact of Poor Sleep Hygiene on Human Behavior |
| Area: CBM; Domain: Applied Research |
| MICHELLE DUDA (University of South Florida), Tonya Bauermann (Queen's University), Derek Duda (Oshawa Clinic Centre for Sleep Medicine), Jonathan A. Worcester (University of South Florida) |
| Abstract: Sleep disorders have been well documented in the medical and psychological literature across the lifespan (Kryger et al., 2000). For example, the prevalence of sleep disorders has been estimated in 25-30% of all elementary-school-aged children, and 13% of adolescents (Horn & Dollinger, 1997). Similarly, Durand (1998) reported approximately one-third of individuals with disabilities are affected by deprived or disordered sleep. Despite the high prevalence rates of sleep problems, little attention has been paid to the impact of sleep disorders upon behavior, particularly with respect to inconsistent or disrupted sleep hygiene (e.g., bedtime routines, external noise or light, excessive heat or cold, overcrowded sleeping area, alcohol/drug abuse). The purpose of this poster presentation is to inform behavior analysts of the importance of sleep hygiene as a setting event capable of predicting future occurrences of challenging behavior. Sleep hygiene will be operationally defined with examples of observable behaviors across the lifespan. Case examples will be provided to illustrate the impact of poor sleep hygiene on outcomes for preschoolers, children, adolescents, and adults. Finally, recommendations will be offered to improve sleep hygiene and to improve bedtime routines (e.g., task analyzing bedtime routines, graduated extinction, bedtime fading, using sleep diaries, scheduled awakening). |
| |
|
| 53. Support for the Health Compliance Model-II Across Cultures |
| Area: CBM; Domain: Service Delivery |
| ELAINE M. HEIBY (University of Hawaii), Carrie L. Lukens (University of Hawaii), Harald Barkhoff (University of Hawaii), Wolfgang Schlicht (University of Stuttgart), Roberto Rojas (University of Stuttgart) |
| Abstract: The Health Compliance Model-II (Frank, 2000) is derived from Staats' (1996) psychological behaviorism theory. The Model posits that compliance to all health promotion habits is partly a function of emotional-motivational (e.g., values health) or verbal-emotional (e.g., worries about health) behavioral repertoires. Other determinants posited to vary across health behaviors include facilitating conditions/discriminative stimuli, consequences, and language-cognitive and sensory-motor behavioral repertoires. We tested whether the Model predicted compliance to 12 health behaviors for samples living in a temperate versus subtropical climate because of different facilitating conditions/discriminative stimuli for exercising regularly. Method. 109 college students at the University of Hawaii or the University of Stuttgart completed twice over a five-week interval the Health Behavior Schedule-II, a questionnaire measuring 45 of the Model's compliance predictor variables (Frank, Heiby, & Lee, in press). Subjects also daily self-monitored 6 health behaviors for five weeks. Results and Conclusions. 37 of the 45 measured Model predictors accounted for a significant portion of the variance for 12 health behaviors. Profiles of predictors differed for the two groups across all health behaviors, suggesting both environmental and behavioral differences in determinants of compliance. Emotional-motivational or verbal-emotional behaviors were significant predictors of all health behaviors across cultures, as expected. KEY WORDS: health behaviors, cross-cultural, Health Compliance Model-II |
| |
|
| 54. Assessment of Barriers to Medication Compliance in the HIV Pediatric Population: A Clinic Review of Cases |
| Area: CBM; Domain: Applied Research |
| ADRIANNA M. AMARI (Kennedy Krieger Institute), Melissa H. Beck (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute), Rachel Piszczor (Kennedy Krieger Institute) |
| Abstract: Children with chronic medical conditions and their families face many challenges in attempting to adhere to complex medical regimens. These challenges are particularly striking for children with HIV, for whom compliance with a complex medication regimen must approach 95% in order to be effective, and for whom results of medication non-compliance can be devastating. The importance of identifying specific factors contributing to less than medically indicated compliance is clear for this population.In the medical setting, medication “non-compliance” is often conceptualized broadly. Applied Behavior Analysis methods can assist in identifying specific barriers to compliance and in operationally defining appropriate targets for clinical intervention. Data will be presented from more than 30 inpatient cases of pediatric HIV referred for behavioral assessment and treatment of medication non-compliance. Functional assessment and task analysis approaches were utilized to identify and operationalize barriers for each case. Data are presented which summarize barriers, and the percentage of cases for which each specific barrier was identified. Results are discussed in regard to the application of behavior analysis methods to assist medical staff in optimizing adherence to medical regimens. |
| |
|
| 55. Behavioral Interventions used to Increase Medication Compliance in Pediatric HIV: A Clinic Review |
| Area: CBM; Domain: Applied Research |
| MELISSA H. BECK (Kennedy Krieger Institute), Adrianna M. Amari (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute), Rachel Piszczor (Kennedy Krieger Institute) |
| Abstract: Non-adherence to antiretroviral medications and its impact on health outcome is a documented problem among children and adolescents (Byrne et al., 2002; Watson & Farley, 1999). A number of potential barriers, both physical and psychological, have been self-reported by adolescents (Murphy et al., 2003) and by the caregivers of children with HIV (Gibb et al., 2003). However, no studies to date have documented how to specifically target these barriers for intervention. The methods of applied behavior analysis can be used to assess child, caregiver/environmental and medication barriers to adherence, as well as to develop specific interventions to increase compliance with complex regimens. This poster will present findings from a clinic review of 32 inpatient cases of pediatric HIV with an emphasis on the behavioral interventions utilized most frequently by clinicians to increase compliance in this population (e.g. pill swallowing training, behavioral escape extinction, positive reinforcement, increased supervision, etc.). Specifically, the percentage of behavioral interventions used that corresponded to operationally defined child, caregiver, and medication barriers to adherence will be discussed. An emphasis will be placed on the importance of using applied behavior analysis techniques with this population to develop targeted interventions across multiple barriers. |
| |
|
| 56. Behavioral Treatment of Complex Regional Pain Syndrome: Functional Rehabilitation and Anxiety Management |
| Area: CBM; Domain: Applied Research |
| LEANNA J. HERMAN (Kennedy Krieger Institute), Melissa H. Beck (Kennedy Krieger Institute), Adrianna M. Amari (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute), Jessica Tischner (Kennedy Krieger Institute), Shreya P. Hessler (Kennedy Krieger Institute) |
| Abstract: Complex Regional Pain Syndrome (CRPS) is a complex chronic pain disorder involving physical, psychological, and behavioral manifestations. Historically, treatment of CRPS has targeted pain reduction through medical intervention. However, functional ability is limited by a combination of factors, including psychological (anxiety) and behavioral (avoidance contingencies).Data will be presented for a 12-year-old girl with a 1-year history of CRPS, and significant functional disabilities. The goals during her 4-week inpatient admission were to increase her ability to bear weight on her legs, ambulate using lower level assistive devices, and tolerate wearing socks and shoes. Differential positive reinforcement with praise and tangible reinforcers was used to increase weight bearing on her affected leg, then walking greater distances, and finally climbing/descending stairs. The patient was trained to use deep-breathing, progressive muscle relaxation and imagery to help manage her anxiety and cope with pain. Galvanic skin response (GSR) was used to measure physiological anxiety, and to document changes in response to relaxation techniques.Behavioral shaping techniques were effective in increasing the patient’s physical functioning, and she reached 100% of her goals by discharge. |
| |
|
| 57. A Functional Analysis for “Pseudo-Seizures” using Duration as the Dependent Variable |
| Area: CBM; Domain: Applied Research |
| RACHEL J. VALLELEY (Munroe-Meyer Institute), Gretchen Scheidel (Mankato State University), Keith D. Allen (Munroe-Meyer Institute) |
| Abstract: The functional analysis technology has been particularly useful for identifying the function of many problematic behaviors that occur frequently with a brief duration (e.g., aggression, self-injurious behavior, noncompliance). However, little research has been conducted examining whether functional analyses are useful and appropriate for low frequency or long duration behaviors. A thirteen-year old male with Cerebral Palsy presented in an outpatient Behavioral Health Clinic with a long-standing history of “pseudo-seizures” that occurred at least 20 times per day lasting approximately 5-60 minutes. No medical explanation for these “pseudo-seizures” had been found. A functional analysis was conducted utilizing duration as the dependent variable to determine the function of these “pseudo-seizures.” Given the duration of this behavior, experimental conditions lasted 25 minutes and modifications to the test conditions were made. Four different experimental conditions (i.e., escape, attention, alone, and control) were completed three times to determine the possible function of the “pseudo-seizures.” Data from the functional analysis demonstrated that the pseudo-seizures served multiple functions; however, the escape condition produced the longest duration “pseudo-seizures.” Challenges of using a functional analysis with duration as the dependent variable will be discussed as well as what types of modifications were made to test conditions. |
| |
|
| 58. Analysis of Predictors of Child Behavioral Distress During Parent-Administered Injections |
| Area: CBM; Domain: Applied Research |
| KEITH J. SLIFER (Kennedy Krieger Institute), Valerie Pulbrook (Kennedy Krieger Institute), Adrianna M. Amari (Kennedy Krieger Institute), Melissa H. Beck (Kennedy Krieger Institute), Lynnda Dahlquist (University of Maryland, Baltimore County), Katia Jones (University of Maryland, Baltimore County), Natalie Vona-Messersmith (Kennedy Krieger Institute) |
| Abstract: Advances in medical care and emphasis on quality of life for children with medical conditions have increased prescription of parent-implemented injections. Little is known about the impact of this arrangement on child distress and on the parent-child relationship. This study was conducted to identify clinical predictors of high distress during parent-administered injections. Data will be presented from 14 dyads with children aged 2 to 10 years diagnosed with Type I Diabetes or Growth Hormone Deficiency video taped during an injection and a non-medical play activity. The injection videos were scored using the Observation Scale Of Behavioral Distress (OSBD). Parents completed ratings of their views about giving injections, as well as their confidence and anxiety about obtaining their child’s cooperation. Correlation analyses identified several easily administered questions that were significantly associated with higher child distress scores. The predictor variable scores also were used to sort subjects into highest vs. lowest quartile groups for visual inspection of the OSBD scores. Results will be discussed in terms of the potential of these parent-reported variables for identifying families in greatest need of behavioral parent training before prescribing parent-administered injections. |
| |
|
| 59. Biofeedback Treatment of Paradoxical Vocal Fold Dysfunction and Respiratory Distress in an Adolescent Female |
| Area: CBM; Domain: Applied Research |
| KEITH D. ALLEN (Munroe-Meyer Institute), Emily Warnes (Munroe-Meyer Institute) |
| Abstract: In paradoxical vocal fold motion (PVCM), the vocal folds adduct during inhalation, restricting the airway opening. Patients typically present with recurrent symptoms of labored breathing and harsh respiratory sounds and report feelings of being choked. Symptoms are often confused with and mistreated as asthma. Treatment of PVCM typically involves teaching individuals to relax the throat via diaphragmatic breathing techniques. The present investigation describes a 16 year old female who presented with a 9 month history of PVCM that had been unresponsive to typical breathing therapy. She was reporting significant respiratory distress and moderate-severe pain 3-4 days per week. She was missing school about 30% of the time. Treatment involved electromyographic (EMG) biofeedback. EMG recordings of vocal fold activity were taken during no feedback baseline conditions and feedback treatment conditions. Treatment was evaluated using a changing criterion design. Results indicated that EMG biofeedback was effective in reducing EMG levels during feedback conditions and during no feedback baseline conditions across 6 weeks of treatment. Reductions were also reported in weekly respiratory distress and pain measures and school attendance improved. Results are discussed in terms of clinical significance of EMG biofeedback as an alternative treatment option for difficult to treat voice disorders. |
| |
|
| 60. The Efficacy of Noncontingent Escape for Decreasing Disruptive Behavior During Dental Treatment |
| Area: CBM; Domain: Applied Research |
| PATRICK M. O'CALLAGHAN (Munroe-Meyer Institute), Keith D. Allen (Munroe-Meyer Institute), Shawn Powell (University of Nebraska Medical Center), Holly Roberts (Munroe-Meyer Institute), Mary Lou Kelley (Louisiana State University), Fouad S. Salama (University of Nebraska Medical Center) |
| Abstract: Researchers have developed and demonstrated the effectiveness of a number of interventions to manage disruptive behavior in the dental setting. However, these treatments vary in terms of their effectiveness, invasiveness, effort to implement, and acceptability to families. This study evaluated the effects of noncontingent escape to reduce disruptive behavior in a pediatric dental setting. Within a multiple baseline design across subjects, four children were provided response-independent breaks via an automated cuing device. Results demonstrated reductions in escape-related behaviors (i.e., crying, body movements, elopement) for all four children. |
| |
|
| 61. The Use of Choice-Based Distraction to Decrease the Distress of Children at the Dentist |
| Area: CBM; Domain: Applied Research |
| HOLLY A. FILCHECK (Beneficial Behavioral Health Services, Inc.), Keith D. Allen (Munroe-Meyer Institute), Hilary Ogren (Munroe-Meyer Institute), Brandt Darby (Munroe-Meyer Institute), Brian Holstein (Munroe-Meyer Institute), Stephen D. A. Hupp (Southern Illinois University, Edwardsville) |
| Abstract: This research was conducted to examine whether choice-based distraction provides an effective means of reducing the distress of children undergoing routine dental treatment. Sixty children between the ages of 5-12 who required restorative dental treatment were assigned randomly to either a Control group or a Distraction group in which the participants were permitted to choose from a variety of music, soundtracks, and/or audio stories to listen to while undergoing dental treatment. They also could change selections during treatment. Direct observations of disruptive behavior provided measures of overall disruptiveness during treatment. The participants also provided self-reported ratings of approval and discomfort. There were no significant differences between the two study groups with respect to average disruptive behavior. However, the Distraction group had significantly fewer participants that would have been considered clinically “uncooperative” and twice as many participants that would be rated “very positive” by dentists. Because choice-based distraction is a relatively easy procedure to implement, it may provide health care professionals and parents alike with a valuable alternative means of reducing the distress of children who visit the dentist. Additional benefits and limitations are discussed. |
| |
|
| 62. Behavior Management Techniques in a Pediatric Medical Setting |
| Area: CBM; Domain: Applied Research |
| MIA A. BERGMAN (Evanston Northwestern Healthcare), Walter Rucker (Private Practice), Shira Benhorin (DePaul University), Jeff O'Koon (Evanston Northwestern Healthcare), Lisa Gold (Evanston Northwestern Healthcare) |
| Abstract: This project reports the results of a six month behavior management program in a Midwestern medical setting/rehab center with a 4 year-old boy. The boy was diagnosed with developmental delays and targeted behaviors included: "Meltdowns" (i.e., tantrums), screaming, paying attention, hitting others, running and pacing, running out in traffic, and toileting. The program involved daily detailed monitoring of these behaviors by the patient's mother, including a structured toilet training program. The patient and members from his family met with the first author on a weekly basis to learn interventions, techniques, and ways to change their own behaviors in order to create positive behavior change in their child. Behaviors were plotted daily on a chart and examined for celeration and variability. Our data indicate that behavioral techniques are highly useful for reducing these types of behavioral problems, as well as appropriate for increasing positive behaviors. |
| |
| |