Behavior Modification最新文献

We examined the effects of combining cognitive training plus aerobic exercise versus cognitive training alone on positive symptoms in recent-onset schizophrenia patients. Sixty-eight participants were randomly assigned to Cognitive Training plus Exercise (CT&E, N = 37) or Cognitive Training alone (CT, N = 31). All participants were also randomly assigned to either oral risperidone or paliperidone palmitate (PP1M) in a concurrent antipsychotic medication study. All participants were provided four weekly sessions of internet-based cognitive training conducted in a group format for 6 months, during which half were randomized to receive a 150 min/week aerobic exercise program. Then participants received 6 additional months of treatment at half of the psychosocial intervention frequency. Reality Distortion, the mean of BPRS ratings of Unusual Thought Content and Hallucinations, was averaged over all available BPRSs during the 3-month pre-baseline period and over four 3-month time periods during the 12 months of intervention. The proportion of BPRS administrations wherein either Unusual Thought Content or Hallucinations was rated >4 was used as a measure of breakthrough psychotic symptoms. Reality Distortion significantly decreased over time for the CT&E group compared to the non-Exercise (CT) group, F(4, 208) = 2.9, p = .02. The proportion of BPRS ratings with breakthrough symptoms decreased over successive 3-month periods for the CT&E group compared to the CT group, F(4, 218) = 6.9, p < .0001. The two medication groups did not significantly differ on either positive symptom outcome, and there were no three-way interactions. Our findings suggest that the enhancing effect of adding aerobic exercise to cognitive training extends beyond cognitive gains and includes positive psychotic symptoms.

Cognitive remediation (CR) is an evidenced-based intervention, but is not consistently included in clinical guidelines, nor implemented widely in mental health services, and is still not fully accepted as a psychological therapy. This is despite demonstrating a boost to recovery, and reductions in health care costs. We describe potential issues as CR matures into a widely accepted and used psychological therapy by drawing on high-quality evidence from reviews and meta-analyses and specifically highlight how CR uses therapeutic formulation, similar to other psychological therapies, to address specific client needs. Most evidence is for those with a diagnosis of schizophrenia, but we also consider CR benefits for other mental health conditions. Data emerging from different health systems are, at last, providing information on how CR is used, disseminated and practice standards maintained. This may be the information needed to support further implementation, expansion, and consolidation of CR use globally.

Many people with serious mental illness (SMI) experience cognitive disabilities and poor independent living skills which limit their ability to live independently in the community. This study examined the feasibility and initial effectiveness of integrating a new cognitive remediation program, Thinking Skills for Life (TSL), into independent living skills training programs in four secure residential treatment facilities (SRTFs) to facilitate discharge to more independent living situations. Participants were 30 individuals in the SRTF, of whom 11 were forensically committed to the SRTF. Results showed the intervention was feasible to implement, with 97% of participants exposed to TSL and 67% completing the program. Initial promise of the TSL program at improving independent living was suggested by post cognitive program discharge to less restrictive living situations of 63% of participants not on forensic commitment, and 55% of those on forensic commitment. These promising findings set the stage for more rigorous evaluation of the efficacy of the TSL program.

The present single-case quasi-experimental study monitored changes in target behavior and experiential avoidance (EA) in an individually delivered, 10-session weekly acceptance and commitment therapy intervention. Participants were three university students with elevated EA who endorsed varying mental health concerns. Primary outcome and process variables were daily measures of clinically relevant behavioral excesses (CRB-E) and daily participant-rated EA, respectively. Additionally, we collected weekly measures of EA, along with pre-, mid-, post-treatment, and 3-month follow-up clinical outcome measures. Overall, synchrony across daily, weekly, and pre/post nomothetic measures was largely observed across participants, and findings suggested improvement in clinical outcomes for two of three participants. Daily measurements of CRB-E and EA fluctuated considerably within both baseline and intervention phases. Cross-lagged correlation analyses revealed no evidence of temporal precedence of change in daily measured EA over change in daily measured CRB-E (or vice versa). Implications of these findings and directions for future research are discussed.

Visual analysis is the primary method to detect functional relations in single-case experimental design (SCED) research. Meta-Visual-Analysis (MVA) is a novel approach used to synthesize SCED data where the estimated effect size measures are principally anchored to primary aspects of visual analysis: change in the magnitude of level, trend, variability, and trend-adjusted level of projected trends. For each of these aspects, percentage point differences between baseline and intervention conditions are estimated and quantified for every participant across studies. MVA effect sizes are standardized, and their aggregates are graphically displayed in a manner similar to individual SCED graphs. MVA graphs are compared and visually analyzed with the aim of better understanding the effectiveness and generality of interventions across SCED studies. In this discussion paper we provide general steps to conduct an MVA and describe MVA's utility in reviewing, organizing, and directing future SCED research syntheses.

Sleep deprivation is a common health condition among people with intellectual disabilities. Studies have linked sleep problems with challenging behaviors. However, it is unclear if there is a consistent effect on challenging behavior and what reinforcement mechanism(s) might be involved. A systematic review of PsychINFO, PubMed, and Scopus identified seven studies meeting the inclusion criteria that had been published over the past 50 years. Data were extracted regarding participant characteristics, specific aim, sleep deprivation, functional behavioral assessments, results, and key findings. Studies consistently reported increased rates of challenging behavior following bouts of sleep deprivation. Five of the seven studies demonstrated negative reinforcement as the mechanism associated with increased challenging behavior. Results were unclear or lacking for other reinforcer mechanisms. Current evidence shows that sleep deprivation can increase negatively reinforced challenging behavior, but automatic and positive reinforcement mechanisms may be unaffected. Theoretical and practice implications are discussed.

In vivo therapeutic coaching of parent-child interactions is the primary mechanism of change in behavioral parent training programs such as parent-child interaction therapy (PCIT), yet relatively little research has examined the coaching process. The primary aim of this study was to explore the bidirectional interaction between therapist-parent dyads to better understand how therapists influence parent behavior and vice versa. Observational data from two research projects were analyzed separately and together using lag sequential analysis (LSA). Results demonstrate that therapist responsive coaching (e.g., praising parent behavior) led parents to use more child-centered skills. Responsive coaching techniques led to immediate increases in parents' use of the targeted positive parenting skill (10%-25% re-use). Responsive strategies followed targeted parent verbalizations more often than directive strategies, suggesting that therapists reinforce positive parenting skills as soon as parents use them. When directive coaching techniques were used, there was a 18% to 32% chance that parents followed through with a child-centered skill as coached. This study is the first to explore the influence of in vivo coaching on parent skill acquisition on a micro-level and has implications for the therapist training.

The psychometric properties of the Reward Probability Index (RPI), which assesses environmental reward as an indirect measure of response-contingent positive reinforcement (RCPR), were estimated in a Mexican population. With the voluntary participation of 1297 adults, reliability was assessed, and evidence was collected regarding the internal structure and its relationship with emotional symptomatology and other variables. Good internal consistency indices (ω and α) were found for both the total scale and its dimensions. A two-dimensional structure, comprising Reward Probability and Environmental Suppressors, and a second-order factor consistent with RCPR theory, was confirmed. This model demonstrated measurement invariance across sex, mental health treatment status, and the presence or absence of emotional symptomatology. Consistent relationships were observed between RPI scores and emotional symptomatology, psychological inflexibility, and life satisfaction. Additionally, evidence was found supporting the criterion validity of the RPI in relation to depression. RPI is a psychometrically solid instrument, and its use is recommended in the Mexican population to account for environmental reward, utilizing a total score and by dimensions.

A reversal design (i.e., ABAB) was used to examine whether increasing steps correlate with higher levels of student interactions. Furthermore, does allowing educators to monitor their steps and set step goals enhance the potential for intervention adoption and lead to lasting teacher behavior change? Each pre-service inclusive early childhood special education teachers were in the final year of their preparation program, during their student teaching practicum. The study took place in two public k-5 elementary schools situated in a mid-size city (approximately 52K in population) in the Southern United States. In addition to visual analysis procedures, nonoverlap of all pairs was used to assess overlap, and Tau-U were used to calculate effect size. The research questions were: (1) Does goal setting and step counting increase the physical steps taken by educators during instruction?; 2) Is there a functional relation between steps taken and teacher-student interactions?; and (3) Are step increases a socially valid approach for increasing teacher-student engagement? Although the results point to minor (positive) effects on teacher steps, the data's variability prevents us from drawing conclusions about the relationship between independent and dependent variables. Nonetheless, when comparing baseline levels to MSI behaviors, we can observe meaningful shifts in a therapeutic direction in the MSI data.. Implications for research and practices are also presented.