应用行为经济学建模治疗相关决策:护理者视角在时间延伸行为治疗。

Shawn P Gilroy, Brent A Kaplan
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引用次数: 11

摘要

针对具有破坏性和挑战性行为的儿童的循证行为疗法很少能立即改善他们的行为。对于参与行为疗法的护理人员来说,这些努力的好处在大量的时间承诺之后才会显现出来。与挑战性行为(即行为改善)的缓解相关的延迟可以影响照顾者如何决定应对问题行为的实例,反过来,他们对需要长期实施以改善儿童行为的治疗的持续承诺(即完整性,依从性)。本研究应用延迟折扣方法来评估延迟如何影响照顾者对管理孩子行为的选择的偏好。具体来说,方法被设计用来评估护理者对更有效的推荐方法的偏好受延迟(即治疗周数)影响的程度。也就是说,在评估的方法中,看护者选择忽略最优的、延迟的策略,而选择追求次优的、即时的策略。结果表明,护理人员经常低估更有效治疗的价值,当与最佳方法相关的延迟变大时,选择追求次优方法。护理人员在临床(即干预)和非临床(即金钱)类型的决策中表现出类似的次优选择模式。这些发现与强调时间偏好作为个体因素可能与护理者坚持长期循证治疗有关的研究一致,并鼓励将行为经济学方法纳入更好地理解护理者的决策。
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Modeling Treatment-Related Decision-Making Using Applied Behavioral Economics: Caregiver Perspectives in Temporally-Extended Behavioral Treatments.

Evidence-based behavioral therapies for children with disruptive and challenging behavior rarely yield immediate improvements in behavior. For caregivers participating in behavioral therapies, the benefits from these efforts are seldom visible until after substantial time commitments. Delays associated with relief from challenging behavior (i.e., improved behavior) can influence how caregivers decide to respond to instances of problem behavior, and in turn, their continued commitment (i.e., integrity, adherence) to treatments that require long-term implementation to produce improvements in child behavior. This study applied delay discounting methods to evaluate how delays affected caregiver preferences related to options for managing their child's behavior. Specifically, methods were designed to evaluate the degree to which caregiver preferences for a more efficacious, recommended approach was affected by delays (i.e., numbers of weeks in treatment). That is, methods evaluated at which point caregivers opted to disregard the optimal, delayed strategy and instead elected to pursue suboptimal, immediate strategies. Results indicated that caregivers regularly discounted the value of the more efficacious treatment, electing to pursue suboptimal approaches when delays associated with the optimal approach grew larger. Caregivers demonstrated similar patterns of suboptimal choice across both clinical (i.e., intervention) and non-clinical (i.e., monetary) types of decisions. These findings are consistent with research that has highlighted temporal preferences as an individual factor that may be relevant to caregiver adherence to long-term evidence-based treatments and encourage the incorporation of behavioral economic methods to better understand caregiver decision-making.

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期刊介绍: Research on Child and Adolescent Psychopathology brings together the latest innovative research that advances knowledge of psychopathology from infancy through adolescence. The journal publishes studies that have a strong theoretical framework and use a diversity of methods, with an emphasis on empirical studies of the major forms of psychopathology found in childhood disorders (e.g., disruptive behavior disorders, depression, anxiety, and autism spectrum disorder). Studies focus on the epidemiology, etiology, assessment, treatment, prognosis, and developmental course of these forms of psychopathology. Studies highlighting risk and protective factors; the ecology and correlates of children''s emotional, social, and behavior problems; and advances in prevention and treatment are featured. Research on Child and Adolescent Psychopathology is the official journal of the International Society for Research in Child and Adolescent Psychopathology (ISRCAP), a multidisciplinary scientific society.
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