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| #401 Poster Session - CBM |
| Monday, May 30, 2005 |
| 5:30 PM–7:00 PM |
| Southwest Exhibit Hall (Lower Level) |
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| 47. Data Entry Performance of Chronically Unemployed Cocaine-Dependent Adults in a Therapeutic Workplace Business |
| Area: CBM; Domain: Applied Research |
| KARLY N. DIEMER (Johns Hopkins University School of Medicine), Carolyn Carpenedo (Johns Hopkins University School of Medicine), Todd W. Knealing (Johns Hopkins University School of Medicine), Conrad J. Wong (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University School of Medicine) |
| Abstract: The Therapeutic Workplace is a treatment that employs participants with histories of drug abuse and unemployment to serve as data entry operators. The intervention has two phases. The initial phase is designed to initiate drug abstinence and establish the needed job skills. Once abstinent and skilled, participants are hired to serve as data entry operators. In the initial evaluation of this intervention, participants were taught academic (e.g., reading, spelling) and job (e.g., typing) skills during the training phase. To reduce the duration and costs of training, the training phase was modified to focus only on teaching job skills. This presentation will report on the success of this focused program in preparing 25 adults with histories of drug addiction and unemployment to serve as data entry operators. A sample of the data entry performance of the first 11 participants showed that participants all maintained data entry accuracies above 99.6% correct, but there was nearly a two-fold difference in the number of characters entered per hour (1,882 to 3,697) and in the hourly productivity pay ($3.42 to $6.50). Preliminary data show that graduates of the focused training program generally served as competent data entry operators, although there was considerable variability in productivity. |
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| 48. Staff Training and Quality Assurance Procedures for Conducting Quantitative Urinalysis Testing for Cocaine Abstinence Reinforcement Procedures |
| Area: CBM; Domain: Applied Research |
| MICK J. NEEDHAM (Johns Hopkins University School of Medicine), Haley Brown (Johns Hopkins University School of Medicine), Todd W. Knealing (Johns Hopkins University School of Medicine), Conrad J. Wong (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University School of Medicine) |
| Abstract: Abstinence reinforcement using qualitative urinalysis testing can be effective in promoting cocaine abstinence in many, but not all patients. Under qualitative testing, urine samples are considered negative if the concentration of the cocaine metabolite, benzoylecgonine, is below 300 ng/mL. However, toxicological studies suggest that some individuals may provide urine samples that exceed the 300 ng/mL threshold for several days after initiating abstinence. Reliance on qualitative testing may require that participants remain abstinent for several days before abstinence can be reinforced. Preston and colleagues (1997) developed a potentially more sensitive quantitative method that arranges abstinence reinforcement based on amounts of decreases in benzoylecgonine concentrations across days. Whereas most of the qualitative testing process is automated, quantitative testing requires additional manual dilutions of urine samples, which can introduce human error. Here we report the results of staff training and quality assurance procedures to ensure accurate and reliable quantitative cocaine urinalysis testing. The procedures were successful in maintaining reliable results across multiple staff members, although occasional human errors were made. These results suggest that quantitative testing can be used appropriately in arranging abstinence reinforcement, however, the occasional errors suggest that staff and patients should be encouraged to request retesting of questionable results. |
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| 49. Designing Sensitive Abstinence Reinforcement Procedures Based on Analyses of Urinary Benzoylecognine Concentrations in Regular Cocaine Users |
| Area: CBM; Domain: Applied Research |
| TODD W. KNEALING (Johns Hopkins University School of Medicine), Mick J. Needham (Johns Hopkins University School of Medicine), Conrad J. Wong (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University School of Medicine) |
| Abstract: Abstinence reinforcement using qualitative urinalysis testing can effectively promote cocaine abstinence in many, but not all patients. Samples tested qualitatively are considered negative if the concentration of the cocaine metabolite, benzoylecgonine, is below 300 ng/mL. However, toxicological studies suggest that some individuals may provide urine samples that exceed that value for several days after initiating abstinence. This makes the reinforcement of recent abstinence difficult. Preston and colleagues (1997) suggested a potentially more sensitive quantitative method that arranges reinforcement when benzoylecgonine concentrations decrease by about 30% per day. Although there is a reasonable basis for selecting this magnitude of decrease, little is known about the patterns of decreases typically seen in regular cocaine users, which could be available for reinforcement. The study examined the patterns of changes in urinary benzoylecognine concentrations in samples collected 3 times per week over 7 months in 56 cocaine-dependent methadone maintenance patients. Data show that decreases in concentration above 30% per day are common in this population. Larger decreases are more predictive that a participant will ultimately provide a sample that reaches the qualitative requirement for cocaine abstinence. The effects on admittance into the workplace are considered for different decrease requirements. |
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| 50. Professional Demeanor of Chronically Unemployed Cocaine-Dependent Methadone Patients in a Therapeutic Workplace |
| Area: CBM; Domain: Applied Research |
| CAROLYN CARPENEDO (Johns Hopkins University School of Medicine), Mick J. Needham (Johns Hopkins University School of Medicine), Todd W. Knealing (Johns Hopkins University School of Medicine), Conrad J. Wong (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University School of Medicine) |
| Abstract: Unemployment among users of illicit drug is common, but the causes of this problem are not well understood. The purpose of this study is to assess the extent to which users of illicit drugs display unprofessional behavior in an employment setting, which might limit their success in the workplace. This research was conducted in a Therapeutic Workplace, a model employment-based treatment program for chronically unemployed adults who have long-histories of illicit drug use. Unemployed adults enrolled in methadone treatment in Baltimore City, who met DSM criteria for opiate and cocaine dependence, and who continued to use cocaine during methadone treatment were hired to work in the Therapeutic Workplace for 4 hours every weekday for 6-7 months. This study examined the frequency of undesirable workplace behaviors and violent, aggressive, and threatening workplace behaviors. Results show that while the overall incidence of many undesirable behaviors is low, there is a small percentage of participants that have serious workplace behavior problems. While substance abuse has been found to be a barrier to gaining and maintaining employment, this study shows that unprofessional behavior in the workplace could also contribute to chronic unemployment in this population. |
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| 51. A Treatment for Chronic Alcohol and Drug Users in Mexico: A Single Participant Design |
| Area: CBM; Domain: Applied Research |
| MARIA JOSE MARTINEZ RUIZ (National Autonomous University of Mexico), Lydia Barragan (National Autonomous University of Mexico), Hector Ayala (National Autonomous University of Mexico) |
| Abstract: The National Addiction Survey (2002) reported that 30 million persons have problems with alcohol consumption in Mexico. A 10% of the population has severe alcohol dependence and 5.4 millions of Mexicans reported drug consumption. The National Development Plan (1995 – 2000) assumes the addictions as one of the principal health problems. The School of Psychology of the National University of Mexico offers a treatment program for alcohol and drugs chronic users. This program is based on cognitive and behavioral theories and techniques, and it’s an empirically supported intervention model for alcohol and drug dependence (Hunt & Azrin, 1973). This intervention model is supported on contingency management, Social Learning Theory and Behavioral economics. During treatment, clients are trained to establish a reinforcement system of alternative rewards for the incompatible behaviors to substance abuse (Bickel, DeGrandpre & Higgins, 1993, 1997; Carroll, 1993). We report the results of such an intervention.A drug user was trained under the treatment model described above; the results showed that the patterns consumption and the dependence levels of the consumer decreased after treatment and the auto efficacy and daily life satisfaction levels of the user increased. These positive outcomes were maintained during a one year follow up. |
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| 52. The Use of Correspondence Training as a Treatment for ADHD |
| Area: CBM; Domain: Applied Research |
| BRIGITTE M. JOHNSON (University of Iowa), John A. Northup (University of Iowa), Terry S. Falcomata (University of Iowa), Kelly M. Vinquist (University of Iowa), Jason M. Stricker (University of Iowa), Brenda Engebretson (University of Iowa), Amanda Hornaday (University of Iowa) |
| Abstract: Correspondence is the degree of agreement between verbal and nonverbal behavior, or “saying” and “doing.” Correspondence training has been shown to be an effective method of increasing a variety of behaviors across a variety of populations. However, only one study (Paniagua, 1987) has demonstrated the effective use of correspondence training for children with ADHD. Correspondence training may be especially beneficial for children with a diagnosis of ADHD for several reasons. Correspondence may be taught across any number of problem behaviors, correspondence training might enhance generalization across settings, and the development of correspondence may aid in the development of self-regulation more generally.We conducted correspondence training for two children ages 5 and 6 with ADHD. Following assessment, correspondence training was conducted sequentially across three target behaviors; number of problems completed, hand raising for assistance, and delay (waiting). Following demonstrated correspondence, participants were prompted to state a progressively higher goal for each target behavior. Results showed that correspondence was maintained and target goals were achieved for each behavior for both children. Generalization data are being collected in the children’s classroom throughout the school year. Preliminary results suggest support an increased use of correspondence training for young children with ADHD. |
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| 53. The Use of Biofeedback in the Treatment of PTSD in a Girl with a Spinal Cord Injury |
| Area: CBM; Domain: Applied Research |
| JESSICA TISCHNER (Kennedy Krieger Institute), Melissa H. Beck (Kennedy Krieger Institute), Deborah Kruglak (Kennedy Krieger Institute), Shannon McIntosh (Kennedy Krieger Institute) |
| Abstract: Spinal cord injury (SCI) affects a child with sudden physical and emotional changes. Emotional reaction to spinal cord injury may include depression, anxiety, and anger (King, C., & Kennedy, P., 1999).Data will be presented on a 17-year-old female inpatient who was referred due to difficulty coping with a SCI. Results from a behavioral assessment showed that the patient met DSM-IV criteria for Post Traumatic Stress Disorder (i.e. recurrent dreams regarding accident, impaired daily functioning for at least one month, avoidance of stimuli associated with trauma), which was causing her distress and limiting her rehabilitation gains. Skin conductance biofeedback was used to assess increased physiological arousal associated with memories of her accident.Treatment consisted of developing a hierarchy of anxiety-provoking stimuli associated with her trauma and systematic desensitization was used to help her cope with anxiety. Patient used deep breathing and distraction strategies to reduce her anxiety as she moved up the hierarchy. Treatment was practiced and generalized in various environments. The intervention resulted in decreased anxiety levels and ability to approach stimuli associated with the trauma. Skin conductance biofeedback post-treatment demonstrated a significant decrease in physiological arousal. |
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| 54. Diagnosing Depression: The Value of Syndromal Versus Functional Assessment |
| Area: CBM; Domain: Applied Research |
| SARA J. LANDES (University of Wisconsin-Milwaukee), Laura Dee (University of Wisconsin-Milwaukee), Andrew Busch (University of Wisconsin-Milwaukee), Jonathan W. Kanter (University of Wisconsin-Milwaukee), Glenn M. Callaghan (San Jose State University) |
| Abstract: Major Depressive Disorder (MDD) is construed by the medical community as a pathological neuropsychiatric disease state that may co-occur with other mental disorders, such as Anxiety Disorders or Alcohol Dependence. However, efforts to identify this disease state independent of co-morbid disorders highlights problems with the syndromal model. The current study presents results of our effort to identify MDD using the major syndromal diagnostic system—the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-R)—for the purpose of evaluating inclusion and exclusion criteria for a study of behavioral treatment of depression. We found that in 0 of 8 cases do the screening and diagnostic interviews present a clinical picture of MDD in line with the disease state model. Instead, results suggest the phenomenon of depression may be better conceptualized as a hypothetical construct that does not exist independent of behavioral problems identified by the clinical interviews. The current study additionally presents initial data on an alternative, functional assessment system that leads to the direct identification of behavioral treatment targets and makes no assumptions about hypothetical disease state entities. These findings lead to the question of whether the participants currently included in this and other studies accurately reflect the population entering treatment. |
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| 55. Prevalence of Risk of Eating Disorders in Almería, Spain |
| Area: CBM; Domain: Applied Research |
| INMACULADA GOMEZ BECERRA (University of Almeria, Spain), Ramon de las Heras Rodriguez (Fundación Unicodesa, Almería, Spain), Manuel Gonzalez-Abreu (Unidad de Pediatría, Hospital Torrecardenas, Almería, Spain) |
| Abstract: This is an epidemiological study of the prevalence of risk of the eating disorders (anorexia nervosa and bulimia), and other objective is to analyze different factors of risk. The sample (890 adolescents) is representative from all the adolescent population who were studying the first grade and the second grade school (12-17 years old) in the Almería town. This work focused mainly in the answer to a EAT-40 questionnaire (Eating Attitudes Test) and other questionnaire entitled FTCA (Search of possible factors related with eating disorders) elaborated with this proposal was used. In this study we found 8% prevalence of risk and different variables of relation (concern for the corporal image, desires to change the own body and excess to be looked in the mirror, influences of the media, excessive use of diets, the aesthetics as reason to make diets and sport, influences of the friends worried by the corporal image, bigger easiness to vomit, feelings and negative thoughts after eating, influence of personal conflicts not solved). The results are analyzed with preventive character. |
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| 56. Behavior Analytic Understanding of the Cognitive Therapy Rationale and Role of Demand Characteristics in Psychotherapy |
| Area: CBM; Domain: Applied Research |
| JENNIFER LEONARD (University of Wisconsin-Milwaukee), Jordan T. Bonow (University of Wisconsin-Milwaukee), Andrew Busch (University of Wisconsin-Milwaukee), Jonathan W. Kanter (University of Wisconsin-Milwaukee) |
| Abstract: Behavior analytic understanding of the Cognitive Therapy rationale and role of demand characteristics in psychotherapy.Jennifer Leonard, Jordan Bonow, Andrew Busch, Jonathan Kanter,University of Wisconsin-MilwaukeeCognitive Therapy (CT) for Depression is the most widely-used and widely-researched of the empirically-supported psychotherapies for depression, but it can and needs to be improved as it does not help all who receive it. A behavioral analysis of CT calls into question many aspects of the approach. In particular, the current research focuses on the accuracy of the cognitive rationale that states that thoughts always lead to feelings. Instead, behavior analysis conceptualizes the relation between thoughts and feelings as behavior-behavior which suggests that feelings can lead to thoughts as much as thoughts can lead to feelings. The current research also points to unintended negative consequences if a therapist presents the CT rationale rigidly to clients without an appreciation for behavior-behavior relations and the larger environmental context in which they occur. The current study presents the cognitive rationale (thoughts cause feelings) and an alternative rationale (feelings cause thoughts) to undergraduate participants to determine if participants would be differentially influenced by these rationales, and presented the rationales in a high-demand and low-demand version to isolate the role of demand characteristics. Results provide support both for a behavioral view of the CT rationale and for the role of experimental and psychotherapeutic demand characteristics. |
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| 57. The Effects of the Homi.Info Web-Based Support Service System in Korea |
| Area: CBM; Domain: Service Delivery |
| EUN JUNG SEO (Daegu University, South Korea), Mi-Kyung An (Daegu University, South Korea) |
| Abstract: The study had two purposes to evaluate the effectiveness of Homi.info web-based support service system. First, it was to see if the Homi.info service could increase clients’ independent self-help skills in their daily contexts.Second, it was to see if the Homi.info service could increase clients’appropriate behaviors as well as decrease clients’inappropriate behaviors.The Homi.info web-based support service system in the study was consisted of four phases of the systems, such as Consultation, Counselling, Diagnosis, & Homi Info. support system.The first phase, consultation was consisted of parent's awareness of the child's problems and referral to the service facilities. The second phase, Counselling system was to counsell through counselling center, schools, hospitals, and universities. The third phase, Diagnosis was to diagnosis based on evaluations, diagnosis systems, and the clients' informations collected from the previous two steps. The last step, Homi.Info support services were included consulting system across cities through regional network, educational support system through evaluation of education and threapy, behavioral and medical support system through behavior analysis and medical network, rehabilitation and information support system through rehabilitation and social welfare, and the clients’ improvements & evaluation.The results of the study showed that 0%-5% stable levels of correct responses of the self-help skills before the introductions of the Homi.info support system were dramatically accelerated up to 80-100% levels for the clients after the introduction of the support systems. In addition, their inappropriate behaviors were decreased 0-10% level and also the appropriate behaviors were increased 80-100% level. Furthermore, the reliability of dependent variables was 92.5%, so the Homi.info support system was reliable for the improvement of the behaviors. |
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| 58. Clinical Intervention in the Age of Managed Care: Implications from a Behavior-Analytic Perspective |
| Area: CBM; Domain: Theory |
| SIMONE NENO (Universidade Federal do Para) |
| Abstract: The delivery of clinical services after the advent of the managed care system is examined in this work in order to highlight some of its outstanding features and the (in)compatibility of these with a behavior-analytic approach to psychological problems. Some of those features are: a) an increasing intervention of managed care companies in the definition of diagnosing references, basically through the use of the categories of DSM-IV; b) the selection, by managed care companies, of the type of therapy acceptable for each diagnostic category; c) the definition, by managed care companies, of the number of sessions adequate for the treatment of each “disorder”; d) the need to achieve the status of “empirically validated” treatment; e) the need to use DSM-IV criteria to estimate the success of interventions; f) the definition of treatment costs by managed care companies; g) the reduced autonomy of professional associations in the definition of treatments scope and costs. Besides the great impact in the delivery of clinical services in general, these features oppose to non-statistical designs in evaluating the efficacy of treatments, are incompatible with idiographic diagnostic procedures, and favor internalist (often organicist) perspectives in the interpretation and treatment of psychological problems. |
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| 59. A Hard Look at the "Biological Causation" Rhetoric: The Marshall Project One Year Later |
| Area: CBM; Domain: Theory |
| W. JOSEPH WYATT (Marshall University), Donna Midkiff (Marshall University) |
| Abstract: Our professional and popular cultures are awash with claims of biological causation of abnormal behavior. Turf battles between organized psychiatry and other treating professions, financial interests of the pharmaceutical industry and other factors account for much of the "hype." At Marshall University we have developed a three CE training package that addresses these issues, including a hard look at the relatively sparse data in support of biological causation of disorders such as the majority of depressions, anxiety disorders, child conduct disorders, ADHD and others. The poster will present the impact of the training on the verbal behavior of about 100 treating professionals who have completed the training. Data are presently being analyzed and are encouraging. |
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| 60. Behavioral Relaxation Training and Relaxation States |
| Area: CBM; Domain: Applied Research |
| NICOLE RIEFESEL (Central Missouri State University), Michael Buermann (Central Missouri State University), Christopher J. Talley (Central Missouri State University), Amy Sanders (Central Missouri State University), Duane A. Lundervold (Central Missouri State University) |
| Abstract: Relaxation training methods emphasize bodily, cognitive or physiological aspects of relaxation. Behavioral Relaxation Training (BRT) targets training of overt motor behavior and covert observational responses. All relaxation training methods are assumed to produce change in subjectively reported states of arousal. However, little is known about these effects. Seven undergraduate participants, with no history of relaxation or biofeedback training, took part. Use of over the counter or prescription stimulant or depressant medication was controlled. Five sessions of BRT were conducted. A repeated pre-post training assessment single-subject research design was used. Following a brief adaptation period, baseline assessment of relaxed behaviors occurred followed by BRT and then post-training observation. Relaxed behaviors were taught according to Poppen (1998). Dependent variables were the Behavioral Relaxation Scale (BRS), a direct observation measure of relaxed behavior and Smith Relaxation States Inventory (SSRI), a self-report instrument. BRS reliability ranged from 80-100%. Systematic increases in relaxed behaviors occurred following BRT. Increases occurred among all 14 relaxation states with greater change (> 1.5 sd) in R-States of disengagement, physical relaxation, mental quiet, rested, strength, childlike innocence, and timelessness. Further research using a more rigorous experimental design and multiple biobehavioral measures is needed. Generality to clinical samples needs to be assessed. |
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| 61. Comparison of Three Stimulus Preference Assessment Methods in Adults Diagnosed with a Mental Illness |
| Area: CBM; Domain: Applied Research |
| STACI L. SAYLORS (University of the Pacific), Holly Ayn White (University of the Pacific), Carolynn S. Kohn (University of the Pacific) |
| Abstract: The purpose of this study is to compare the results of three stimulus preference methods in verbal adults diagnosed with a mental illness. Past research has indicated that multiple-stimulus preference assessments can produce similar results to those achieved using the paired-stimulus presentation format. However, current research on stimulus preference assessments has focused on individuals diagnosed with severe or profound mental retardation, and individuals with developmental disabilities. Extensive research examining stimulus preference methods in adults diagnosed with a mental illness has not been conducted. This study compares survey preference assessments, paired-stimulus preference assessments, and multiple stimulus preference assessments without replacement with this population and is divided into two phases. During phase 1, a survey method, a paired-stimulus method, and a multiple stimulus without replacement method of assessing preference of edible reinforcers were administered. Phase 2 tested the reinforcement effects of the stimulus preference assessments administered in phase 1. During this phase the highest and lowest ranked stimuli were then delivered contingent on a target behavior in a multielement format. The results of these comparisons will be discussed in terms of application of stimulus preference assessment procedures in adult outpatient settings for community centers of the mentally ill population. |
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| 62. Reducing Anxiety in College Students in Public Speaking Situations |
| Area: CBM; Domain: Applied Research |
| ANGELA M. DUARTE (Universidade Catolica de Goias), Maria Aparecida Oliveira (Universidade Catolica de Goias) |
| Abstract: The study was part of the master level thesis of the first author. A multiple baseline across subjects design was used in the study. Five college students presented high level of anxiety in public speaking situations and in situations where they were being evaluated. Intervention combined applied behavior analysis procedures and procedures of cognitive behavioral therapy to teach anxiety reduction strategies. The results show improvement in the responses measured. |
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