Association for Behavior Analysis International

Animal studies have examined the treatment of drug-seeking behavior with extinction procedures (Crombag and Shaham, 2002; Everitt and Robbins, 2005; Hymin et al., 2006; Millan, Marchant, and McNally, 2011; Mueller, Perdikaris, and Stewart, 2002; Quirk and Mueller, 2008). However, little progress has been made to apply these models to human medical treatment. This clinical case study elucidates a multidisciplinary treatment of a United States Army soldier exhibiting prescription opioid tolerance with poorly controlled trigeminal neuralgia pain for several months following his deployment. Concomitant with brief cognitive behavioral treatment (CBT) for the self-management of chronic pain (Keefe, 1996), the patient underwent extinction procedures for requesting additional opioid medications to treat his pain. This yielded an extinction burst and a dramatic decrease in medication-seeking behavior. Increased daily functioning is an important outcome variable and an indirect measure of self-management skills. This was measured via probes using the Activity Impact Scale. The patients progress was maintained for 6-months, whereby narcotic-seeking behavior remained low and more importantly pain was almost unchanged, and daily functioning improved significantly. Preliminary evidence illustrates one method of applying animal extinction models to drug-seeking behavior to improve self-management of chronic pain. Future challenges include managing relapse and multiple reinforcement contingencies.

Low levels of social activity involvement may have negative implications on overall quality of life for older adults living in residential care settings. Despite the recent growth of assisted living (AL) facilities, few studies have examined social activity participation in this environment. The present study assessed the effects of2 prompt procedures that included different amounts of positive social attention (personalized prompts alone and combined with brief conversation) on the social activity attendance of8 AL residents. Personalized prompts were designed to appeal to each participant based on preference assessments regarding activity interests and preferred types of activity participation. During treatment conditions, increases in attendance occurred not only following treatment prompts, but also during activities that were not preceded by treatment prompts. Similar effects were observed for both treatment prompts. Results suggest that personalized prompts and positive social attention can increase weekly social activity attendance in AL residents.

This study examined the effects of specific instructions on the number of community resource websites visited by4 clients in a locked program for persons with substance abuse and severe mental disorders. In the baseline phase, participants were prompted to explore7 categories of community resources (i.e., housing, employment, discount stores, inexpensive restaurants, medical and social services, parks and recreation, bus routes) using laptop computers with Internet access during 10-minute sessions. In the treatment phase, participants were asked to choose1 of the7 categories of community resources that they were going to explore during the sessions and explain why this was of interest to them. Specific instructions to narrow responding were evaluated within a nonconcurrent multiple-baseline-across subjects design. Windows Internet Explorer history data showed substantial gains in the number ofrelevant websites contacted for3 of the4 participants.

Melanoma is a skin cancer affecting over 68,000 Americans each year and is one of the cancers most responsive to treatment when detected early (www.cancer.gov). Thus, early detection is an important goal. Using a translational approach, the current study evaluated the effects of differing stimuli on generalization gradients of typical adults viewing moles of varying levels of malignance based on symmetry. Fifteen stimuli of equally-spaced iterations ranging from benign (1) to malignant (99) were presented randomly to 2 groups of participants following training. Each group was trained using the same S+ stimulus (50) and differed only in the S- stimulus (1 or 99) with which they were trained. Test stimuli were identical across groups and each stimulus was presented 9 times. Data were collected on the frequency of responses to test stimuli. The study is ongoing; however, current results indicate that generalization gradients did not shift away from the S- stimulus as predicted by previous literature. There appeared to be a bias for responding to stimuli ranked 50 or greater. The study will continue in efforts to identify aspects of the stimuli that may promote gradient shifts such that this methodology can inform procedures for enhancing early detection of melanoma.

Bruxism, defined as the gnashing, clenching, or grinding of the teeth, has been estimated to afflict 5–20% of the general population. Symptoms most commonly associated with bruxing include accelerated enamel loss, tooth abfractions, gum damage, headaches, and jaw and ear pain. Dentists frequently recommend dental restorative surgeries and management of symptoms with a bite splint following discovery of the patient's bruxing. With the health problems and high cost of bruxism care, treatments that effectively stop bruxism are needed. The current study's purpose was to assess the efficacy of a biofeedback device on nocturnal bruxers. The device, Sleep Guard, has an EMG sensor that measures muscle activity in the frontalis muscle, which is associated with bruxing, as well as a tone generator, which is activated once EMG levels breach a certain threshold. The device is fitted on a headband and is worn throughout sleep. Four participants were included in this study. When compared to baseline levels (the Sleep Guard device recorded EMG sans the feedback tone) the activation of the feedback tone resulted in reductions in average EMG levels of 51–79% for three participants. A fourth participant showed no decrements in average EMG levels while wearing the Sleep Guard device. The clinical utility of this device is discussed.

Treating substance use disorders remains challenging and even the most efficacious treatments have limited success. Mindfulness Based Relapse Prevention (MBRP) is a cognitive-behavioral treatment that combines two evidence-based treatments: Relapse Prevention (RP; Daley & Marlatt, 2006) and Mindfulness Based Cognitive Therapy for depressive relapse (Segal, Williams, & Teasdale, 2002). Research on MBRP is limited but suggests it is more successful than TAU in reducing cravings, increasing acceptance, and inoculating users against relapse during increases in depressive symptoms (Bowen et al., 2009; Witkiewitz & Bowen, 2010). The aim of the current study was to examine the efficacy of MBRP against non-mindfulness-based RP in order to gauge the unique contribution of the mindfulness component to RP. The study was conducted in a womens residential substance abuse treatment center. Data collection is ongoing. To date, 15 individuals have completed 15-week follow-up assessment. At this time, none of the MBRP group, (n=8) have indicated substance use relapse compared to 43% of the RP group (n=7). MBRP participants also reported significantly fewer cravings (p = 0.04) and a trend towards greater acceptance (p = 0.11). Initial results suggest mindfulness may augment the RP treatment.

The purpose of this report is to present the fourth year follow-up evaluation of the Brief Alcohol Screening Intervention for College Students (DIBAEU; Quiroga, Cabrera & Vital, 2003) applied with the purpose of reducing alcohol consumption patterns and consumption related problems in university students with diagnoses of mild dependence to alcohol in accordance with the Alcohol Dependence Scale. The average participants' age was 18.6 years (range 18–19 years); who consumed alcohol when entering the program, having 14 years of scholarship on the average (range 13–15 years). The participants were matched to the profile of this specific model program (BASICS, Dimeff, Baer, Kivlahan & Marlatt, 1999), adapted and translated into Spanish by Quiroga & Cabrera (2003), based on the severity and chronicity of their alcohol problems, consumption patterns, consumption related problems, neuropsychological impairment, family history of alcohol problems and treatment goals, in order to have a correspondence between this intervention modality and alcohol consumer's type. We took care that participants didn't present any serious physical illness, didn't require internship, neither they presented other psychiatric disorders of the Axis I of the DSM IV, and in the case of women they were not pregnant or in period of nursing, applying them the Structured Clinical Interview for the DSM-IV Axis I Disorders-alcohol (SCID-I; First, Spitzer, Gibbon, & Williams, 1999). The results showed a high clinical significance in reducing alcohol consumption related problems, based in the Rutgers Alcohol Problem Index and in the Alcohol Dependence Scale, and statistical significance in the "frequency of alcohol weekly consumption" (X = 3.00, SD = 0.00)> (X = 2.57, SD = 0.63), t (41) = 4.407, p = .000, in the "quantity of alcohol consumption per occasion" (X = 5.73, SD = 0.64 ) > (X = 2.93, SD = 0.43), t (41) = 26.483, p = .000; and in the "quantity of alcohol weekly consumption" (X = 17.21, SD = 1.994)> (X = 7.66, SD = 0.52), t (41 ) = 27.848, p = .000. Finally, the results are discussed in terms of their clinical and statistical implications to this model program, noting the main limitations of this investigation and the perspectives that are glimpsed to future.

We tested the effects of DRO on adults self-injurious behaviors during working time. Two adults served as the participants for this study. The two participants were selected due to their self-injurious behaviors (SIBs) such as skipping thumb skin and biting nails while they are working under high pressure environment. The experiment was conducted at an office in a metropolitan area. A time lagged multiple baseline design was implemented for this study. The independent variable was the implementation of DRO to suppress participants target SIBs. During the DRO phase, the supervisor presented rewarding-points when the participant did not emit the target SIBs for consecutive 15 minutes. The points resulted in the back-up reinforcement (e.g., gift card). The dependent variable was the number of instances of SIB per hour. The results demonstrated the DRO using a point-token economy system was effective to decrease the target SIBs for both participants.

The main objective of the investigation was to design and apply a behavioral modification program in order to help the employees of an organization cope with extraorganizational stressors. The main problem was the direct influence that extraorganizational stressors have on some employees performance, feelings, thoughts and health. There were three hypothesis: the treatment program will produce a significant variation in the subjects stress levels, the treatment will not produce a significant variation in the subjects stress levels; there will be a significant variation in the subjects stress levels but will not be caused by the program but by extraorganizational stressors. The treatment consisted in the administration of five main programs: first, the subject learning to relax efficiently by using deep muscle relaxation and diaphragmatic breathing; the second one consisted in listing and ranking stressful events by hierarchy and based on the hierarchy apply relaxation techniques; the fourth and fifth consisted in stress coping thoughts and applying coping skills into real situations. The sample consisted of two male subjects, with 23 and 25 years old, performing administrative roles, both of them suffering from acute stress disorder by the manifestation of disturbing thoughts and physical symptoms. Despite the fact that the disturbances were reduced after the treatment, there were some extra organizational stressors that interfered with our results, which lead us to accept the fact that there were significant variations in the subject stress levels that were not produced by the treatment program.

Diabetes, a chronic disease affecting 25.8 million adults in the United States, doubles the odds of developing depression. Exercise is recommended for both diabetes management and depressive symptom relief; however, this comorbidity is associated with poor adherence to exercise recommendations. Behavioral interventions have been effective in increasing exercise in adults with diabetes, but no studies have examined the effectiveness in a comorbid population. This study used behavioral activation (BA) to address the challenge of increasing exercise behavior in a low-income adult population with comorbid depression and type 2 diabetes. BA focuses on the relationship between behavioral contingencies and mood, thus therapy targets increasing contact with reinforcers through engagement with pleasurable activities, addressing barriers and targeting avoidance. Therapists worked collaboratively with participants to set weekly, manageable exercise and depression goals, address potential barriers, identify reinforcers, and track behavior change. Outcomes measured included self-reported depression and self-care, and self-monitoring of goals met. Data were analyzed using a mixed methods approach (i.e., visual analysis of changing-criterion design and statistical analysis). Results suggest significant and ecologically valid improvements in exercise behavior and mood, and support the use of this individually-tailored behavioral intervention to address contextual factors related to behavior change and mood improvement.

Marijuana is the main illegal drug consumed in Mexico. To address this problem we developed a cognitive behavioral brief intervention, to treat people in early stages of consumption. The program includes an initial evaluation and 5 treatment sessions once a week. Then a follow up at 1, 3, 6 and 12 months were performing. In this paper we analyzed the results of the brief intervention, 52 people received treatment to eliminate drug use. The results showed that 38% ended the intervention and became abstinent. However there was a high drop out (62.9%), with the largest number of persons who abandon (42.3%) in the second session. It discusses factors related to the client, the therapist and the intervention. Motivational intervention was not used to change the client's motivation stage. These results indicate the need to identify the stage of change of the person and according to this, match strategies that promote motivational readiness to change, which indicates the importance of the therapist's role in the process. Lack of motivation was the most important factor (64%).