A proposal for a monitoring and aversive feedback device to maintain drug abstinence or controlled drug use

A device implanted in a patient could monitor blood levels of addictive substances on an intermittent or continuous basis. Excessive levels of a given substance would trigger release of an aversive chemical agent into the bloodstream, in essence creating an artificial allergy. Implications of the concept are discussed.

Treating chronic aggression. Effects and side effects of response-contingent ammonia spirits

The purpose of this study was to evaluate the effects of aromatic ammonia spirits applied contingent upon the severe aggression of a 7-year-old, mentally retarded and behavior-disordered child. A secondary purpose was to test a new method of administering the treatment. A within-subjects, repeated reversals design was used. Across 104 daily sessions, concurrent measures were obtained on aggression, inappropriate vocalizations, participation in planned activities, staring, teacher praise, and teacher touching. During experimental phases ammonia was applied contingent upon aggression and the behavior was abruptly suppressed. Concurrently, levels of untreated inappropriate vocalizations decreased and levels of participation in planned activities increased. These positive side effects diminished slightly after 3 or 4 months of treatment. Both the effects and side effects of treatment, however, were still evident at a 14-month follow-up. Results are discussed in terms of past research with contingent ammonia, side effects of punishment, and treatment precautions.

Olfactory aversion conditioning and overeating: a review and some data

The present study evaluated the efficacy of olfactory aversion conditioning in the management of overeating problems. 42 overweight female subjects were assigned to one of three treatment conditions: olfactory aversion therapy, attention placebo control, and no-contact control. One experimenter administered the 8-wk. treatment phase. The aversion therapy procedure entailed the pairing of selected target foods (CSs) with noxious odors (UCSs). There were 25 pairings of the CS and UCSs during each weekly session. Four noxious odors were employed, one each week, to prevent habituation to the UCS. The attention-placebo control procedure was identical except that "air" was substituted for the putative UCS of the aversion therapy condition. At the end of the treatment period the aversion therapy group had lost 4.7 lb.; the attention placebo controls had lost 3.6 lb. and the no-contact controls 0.5 lb. The difference between the aversion therapy group and the no-contact controls was significant and that between the attention placebo group and the no-contact controls approached significance. At a follow-up 8 wk. after the end of the treatment period the weights of all groups had risen to pretreatment levels and there were no differences between them. These results indicate that olfactory aversion therapy is not an efficient technique in promoting weight-loss.

Behavioural approaches to the management of sexual deviations

The history of treatment approaches used to help individuals troubled by sexual deviation or variation is notable for the way it has reflected the changing attitudes of both society and medicine to such behaviour. In recent years the range of behavioural techniques has broadened considerably with the introduction of, for example, cognitive forms of treatment and a change in emphasis away from the suppression of deviant sexual behaviour and towards the positive development of desired behaviour. In addition, as with behaviour therapy in general, a more flexible approach to management has developed with much greater emphasis on designing treatment on the basis of each individual patient's needs. Furthermore, there has been a marked reduction in the number of requests received for help with deviant sexual interest. This reflects both the changes that are occurring in social attitudes to sexuality in general, and homosexuality in particular, which have reduced the pressures on individuals to abandon their personal styles of sexual behaviour, and the development of self-help groups and minority organisations.

Suppression of pica using brief-duration physical restraint

The present study supported the finding of Bucher et al. (1976) that physical restraint can control pica. However, unlike the earlier study which additionally used a verbal reprimand, physical restraint alone was shown to be effective. Further, this study showed that while all three durations of physical restraint suppressed pica, the duration of 10 s was more effective than either 30 s used with one subject, or 3 s used with the other in alternating treatments designs. The procedure proved simple to use, took minimal staff training time, and required no equipment. During treatment some increase in pica was observed in settings where treatment had not yet been applied but later treatment in these settings quickly controlled the behaviour. Collateral behaviours were largely unaffected except for picking and handling, a precursor for pica, which showed variable changes, with reductions being the only large changes.

Scale of aversiveness of behavioral decelerators

The present report describes measurement of the aversiveness of 10 well-known decelerator techniques. 67 experts in the use of behavior modification completed and returned a questionnaire which asked them to use a numerical magnitude estimation task to produce the scale. Implications and limitations of the scale, which should be of considerable aid in the provision of services for the institutionalized mentally retarded, are discussed.

Treatment of compulsive rituals with visual screening: a case study with long-term follow-up

The present study reports on the use of visual screening, a mildly aversive response suppression procedure, as a treatment for reducing compulsive behaviors in a four and one-half year-old developmentally disabled boy. Two distinct patterns of compulsive responding were observed: repetitive (stereotyped) shoe-related behaviors and a ritualistic shoe-related act. The effect of visual screening on repetitive shoe-related responses was initially evaluated in a laboratory setting under A-B-A-B-B1 experimental conditions and systematically extended to the classroom setting in multiple baseline fashion. Visual screening was also contingently applied as treatment for the shoe-related ritual, with the effects analyzed using a similar multiple baseline format across hospital residential unit and natural home settings. Results of the study indicated that visual screening was an effective treatment for suppressing both forms of the subject's compulsive responding and that it was an easily learned and administered procedure from both staff and parent perspectives. Follow-up data across 12 months were obtained and indicated that the effect of treatment was exceptionally durable.

Using water mist to reduce self-injurious and stereotypic behavior

A mist of water sprayed in the face was used as a punisher for stereotypic and self-injurious behaviors by a boy diagnosed as severely mentally retarded with autistic-like behaviors. The boy had a long history of mouthing and hand-biting behaviors. The latter behavior was evinced by noticeable scar tissue on the backs of his hands. The study took place in a self-contained public school classroom for autistic children and other children with severe communication disorders and functional mental retardation. An ABAB withdrawal design with no treatment probes demonstrated the rapid and dramatic suppressive effects that the response-contingent water mist had on the target behaviors. This procedure was taught to classroom personnel who were able to maintain the suppression with minimal interruption of educational programming for the subject or his peers. No adverse physical effects were observed nor did the child attempt to escape or struggle against the procedure. The results are discussed in relation to ethical considerations and the use of response-contingent aversive stimulation.

Faking "turn-ons" and "turn-offs". The effects of competitory covert imagery on penile tumescence responses to diverse extrinsic sexual stimulus materials

This report describes a single-case study of the differential effects of neutral, moderately aversive, or highly aversive covert images used in covert sensitization on physiological arousal to homosexual stimuli in a bisexual male. During the experiment, data became confounded after it was revealed that the patient had begun using aversive scenes from treatment sessions to block his sexual arousal in assessment sessions. Subsequent investigation determined that this patient could block sexual arousal to extrinsic stimuli presented in laboratory assessment by covertly attending to neutral or aversive stimuli. He could attain sexual arousal with 90% or greater erection in the presence of sexually neutral stimuli by covertly attending to sexually evocative imagery. Implications for treatment and assessment of sexual deviation are discussed.

Effects of covert sensitization on facial EMG: a pilot study

Two subjects currently undergoing covert sensitization treatment were asked to imagine alternately the covert scene and a pleasant imagery scene while EMGs from the corrugator and forearm extensor muscle sites were continuously monitored. Visual inspection of the data suggests that corrugator EMG can reliably discriminate the covert-sensitization scene from the pleasant imagery and from resting baseline conditions. Facial EMG may have potential for objectively studying imagery and its role in covert sensitization and other imagery-based treatments.

Replicable abstinence rates in an alcoholism treatment program

Treatment outcome studies of alcoholism have historically had innumerable difficulties and controversy. Few investigators ever have reported a replication of their initial study results, let alone the crossvalidation of such initial results. This article provides results of a four-year replication study of a medical behavioral treatment approach. Comparisons of patients receiving a uniform treatment were made at yearly intervals. A few variables are identified to clarify who will or will not achieve and maintain follow-up sobriety, although it is admitted that our knowledge in this area is still rudimentary. These results affirm for the practitioner today that the alcoholic patient is treatable with a high probability of success. When the outcome of treatment is positive, the diagnosis and referral become crucial for alcoholism just as for other treatable diseases.

Self-change and therapy change of smoking behavior: a comparison of processes of change in cessation and maintenance

Cigarette smokers who quit on their own (n = 29) were compared with subjects from two commercial therapy programs: Aversion Group (n = 18) and Behavior Management Group (n = 16). Subjects were administered a Change-Process Questionnaire and a demographic and smoking-history questionnaire within seven weeks of successful cessation, then interviewed again in five months. Using a transtheoretical model of change developed by Prochaska (1979) six verbal and four behavioral processes of change and three stages of change (Decision to Change; Active Change; Maintenance) were analyzed. Subjects in each treatment group were middle class, heavy-smoking adults. The change-process analysis of cessation discriminated between the self-quitters and therapy quitters and between the two groups of therapy subjects on five variables. Stages of change interacted with the processes of change in the cessation of smoking behavior. Verbal processes were seen as important in making the decision to change while action processes were critical for breaking the actual smoking habit. Maintenance of cessation was related to, but not dependent on, how subjects actively changed smoking behavior.

Visual screening: an alternative method for reducing stereotypic behaviors

Visual screening, a mildly aversive response suppression procedure, was evaluated across two studies for its effectiveness in reducing topographically similar and dissimilar stereotypic behaviors of four developmentally disabled children. In the first study, a multiple baseline design across subjects and behaviors was used to assess the effectiveness of the procedure as a treatment for reducing the visual and auditory self-stimulatory responses of two 9-yr-old mentally retarded and behaviorally disturbed children. A multiple baseline design across subjects was used in the second study to evaluate the effectiveness of visual screening as a treatment for reducing stereotypic fabric pulling and self-mutilative ear bending, respectively, of two 13-yr-old mentally retarded, autisticlike adolescents. Long-term follow-up data for both studies were reported. The results suggested that visual screening was an easily administered, effective, and exceptionally durable treatment procedure for controlling a variety of stereotypic behaviors commonly associated with the developmentally disabled.

Reduction of disruptively loud voice volume using a "tok-back" device

This study addressed the disruptively loud voice volume of three adult mentally retarded subjects. A reduction in voice volume was affected through the use of the "tok-back" device, a crescent-shaped device made of lightweight plastic, which when fitted over the face covers the mouth and ears and provides feedback on sounds emitted. In Experiment 1, the tok-back was used with two subjects as an aversive consequence to disruptive screaming. The tok-back was placed over the face after each scream and remained in place until the end of a specified period of quiet. Using a multiple baseline across settings design with each subject, results showed a substantial reduction in screaming following the implementation of the tok-back condition. A multi-element design was used in Experiment 2 to compare the effects of baseline, cueing and tok-back conditions on percent of correct responses, responses given in a soft volume, to simple conversational questions with the third subject. Results showed the tok-back condition to result in a higher percent of correct responding then did either the baseline or cueing conditions.

Medical-behavioral treatment of the older alcoholic patient

The purpose of the present research was to assess the treatment effectiveness of a multimodality alcoholism treatment program with older alcoholic patients. Treatment success was defined as 1 year of sobriety following inpatient treatment in a multicomponent program oriented around aversion conditioning to alcohol. A total of 87 patients, 65 years or older, were admitted, and a total of 78 patients were treated in the Raleigh Hills Hospital-Portland over a 2-year period. Descriptive psychological test data, demographic characteristics, and symptom history data were obtained for these patients and related to treatment outcome. This population of elderly alcoholic patients treated as successfully as younger patients. Their abstinence percentage combined for the two treatment years was 65.4% continuous sobriety over a 12-month follow-up period.

Smoking reduction: a comparison of the effectiveness of rapid smoking and increasing delay training

The relative effectiveness of two treatment procedures in facilitating self-control of smoking behavior was compared. One week before treatment, subjects self-monitored number of cigarettes smoked. On the days of treatment, subjects were given pre- and postsession self-control tests; subjects were given a lit cigarette and were asked to withstand the temptation of taking a puff during an imposed delay period. After five days of two-hour sessions in which subjects' smoking was paced with either increasing delays or rapid smoking, subjects again were asked to self-monitor their smoking for one week. Increasing delay induced better self-control scores than did rapid smoking. Both groups were not significantly different in number of cigarettes smoked.

A factorial analysis of preparation, aversion, and maintenance in the elimination of smoking

The present investigation initiated a dismantling strategy in which subjects were assigned to treatment stages (preparation, aversion, maintenance) or to combinations of stages in a factorial design. It was hypothesized that multistage conditions would be superior to single stage conditions and that maintenance would retard relapse. Forty men and 33 women were randomly assigned to one of seven conditions. Results supported both hypotheses although significant effects were no longer evident at 12-month follow-up. Considerable relapse occurred in all conditions. Specific treatment components appeared to be of limited importance as indicated by generally very similar results for preparation and aversion. Booster sessions appeared to be ineffective. Interpretation of the findings is limited, however, by a relatively small subject enrollment in each condition. It was concluded that attempts to isolate extremely precise treatment elements are unlikely to be successful. Suggestions for further research included adoption of more structured maintenance strategies emphasizing coping skills and a more systematic focus upon potentially important process variables, notably group cohesiveness.

Aversive control of bruxism in a mentally retarded child: a case study

Reduction of audible bruxing by an 8-yr.-old, non-verbal boy was effected from baseline (5 days) in 17 days of treatment at school (a contingent verbal No accompanied by the teacher's finger to the child's jaw). Reduction continued at a 3-wk. follow-up and generalized to the home.

Utility of behavioral self-help manuals in a minimal-contact smoking cessation program

The effectiveness of two commercially available smoking cessation manuals was evaluated under minimal therapist contact conditions. Forty cigarette smokers who volunteered to participate in a self-help quit smoking program were randomly assigned to one of three conditions: 18 to Pomerleau and Pomerleau's 1977 manual, 13 to Danaher and Lichtenstein's 1978 manual, and nine to a waiting-list control. Six-month follow-ups indicate that the former manual offers a useful treatment approach, while no firm conclusions can be made regarding the latter manual. Utility of self-help manuals in multilevel treatment programs is discussed.

Compliance, defiance, and therapeutic paradox: guidelines for strategic use of paradoxical interventions

Strategies and tactics in apparent opposition to desired therapeutic goals are discussed in the context of brief problems-focused therapy. Two types of paradoxical intervention are differentiated: in one, change follows from attempted compliance with a therapeutic directive; in the other, change follows from defiance. Brehm's reactance theory and the Palo Alto brief therapy model offer guidelines for the use of such strategies.

Bulimia

Bulimia, also known as compulsive eating, has recently been recognized as a disease. Although bulimia is thought to be common, especially among young women, little is known about it. Theorized causes are primary neurologic dysfunction (epileptiform), disturbance in the appetite/satiety center of the hypothalamus, learned abnormal behavior or unsuppressed oral drive. Diagnosis rests primarily on the symptoms. Possible treatment measures include phenytoin, aversion therapy, psychotherapy and self-help groups.

Current trends in the treatment of self-injurious behavior

This chapter attempted to outline current trends and recent advances in the treatment of SIB. The major focus has been on the behavioral techniques, since it was obvious that at this stage other approaches have little to offer either diagnostically or therapeutically. It was pointed out, however, that these approaches and drug therapy in particular need further investigation before their role in the treatment of SIB can be adequately assessed. This chapter critically evaluated the current behavioral approaches in some depth and advanced several recommendations for future work. The general impression gained from current research is that significant advances have been made in the last decade in our understanding of the problem and that a small number of well-controlled studies have shown that SIB in certain children can be controlled for up to three years. Yet a concerted research effort is required to overcome the methodological problems that appeared with disconcerting regularity in most of this research. It is sobering to note that no current prevalence studies of SIB report a major decline in the prevalence of SIB in pediatric populations despite our current ability to provide some form of meaningful treatment.

Self-initiated, cue extinction, and covert sensitization procedures in smoking cessation

Two studies tested the utility of self-control procedures and covert sensitization as alternatives to rapid smokers in smoking cessation. Subjects were at least 21 years old and had smoked at least one pack per day for at least 5 years. Relaxation training and discussion of goals were given in three meetings per week for 2 weeks prior to subject-chosen quit dates. A total of 10 sessions was held during the 90 days following cessation. In Study I, both groups received self-control strategies. One group also received covert sensitization. At 3-month follow-up, 33% of those without and 27% of those with covert sensitization were abstinent. At 6-month follow-up these percentages were 33 and 13, respectively. Covert sensitization apparently added nothing to the effects of the self-control package. In Study II, one group received the same combination of self-control manual and the basic package as in Study I. A second group received the basic package with cue extinction procedures designed to extinguish associations between desires for cigarettes and cues paired with previous smoking. A third group received a combination of both sets of procedures. At 3-month follow-up, 71 and 60%, respectively, of the first two groups were abstinent, while only 31% of the combination group was abstinent. At 6-month follow-up, these percentages were 29, 27, and 8, respectively. The low abstinence rate for the combination group likely reflects problems associated with presenting too much material in the 2 weeks prior to cessation.

Treatment of assaultive hair pulling in a multihandicapped youth

The course of treatment for hair pulling in a moderately retarded, visually impaired 9-year-old male is described along with the effectiveness of an ammonia inhalation procedure to eliminate this behavior. However, before discovering this successful procedure, other well-known techniques such as DRO, TO, overcorrection, and shaping all failed. Since rapid treatment effectiveness could be assumed to be the norm, given the operant literature, the extensive course of treatment reported here serves to document that perseverance may also be a necessary component of successful behavior management strategies.

Unpleasant and pleasant events, and mood

Investigated the relationships between the daily occurrence of aversive events, depressed mood, and the enjoyment of pleasant events in a sample of 21 depressed patients. Participants were assessed pre-, post-, and 1 month after treatment, on the Pleasant Events Schedule, The Unpleasant Events Schedule, MMPI, Beck Depression Inventory and Grinker Interview Checklist. During treatment participants rated their mood and also indicated the occurrence and degree of (un)pleasantness for 80 of their most pleasant and for 80 of their most unpleasant events each day over a 42-day period. Significant associations were found between depressed mood and unpleasant events, and between unpleasant events and the pleasantness of pleasant events. There was also a significant decrease in experienced aversiveness concomitant with clinical improvement.