Behavior Modification

Eating disorders are among the most challenging disorders to treat, with even state-of-the-art cognitive-behavioral treatments achieving only modest success. One possible reason for the high rate of treatment failure for eating disorders is that existing treatments do not attend sufficiently to critical aspects of the disorder such as high experiential avoidance, poor experiential awareness, and lack of motivation. These variables are explicit targets of Acceptance and Commitment Therapy (ACT). The current study examined the efficacy of an ACT-based group treatment for eating disorders by examining whether the addition of ACT groups to treatment-as-usual (TAU) at a residential treatment facility for eating disorders would improve treatment outcomes. TAU patients received an intensive residential treatment, while ACT patients received these services but additionally attended, depending on diagnosis, either ACT for anorexia nervosa groups or ACT for bulimia nervosa groups. Although individuals in both treatment conditions demonstrated large decreases in eating pathology, there were trends toward larger decreases among those receiving ACT. ACT patients also showed lower rates of rehospitalization during the 6 months after discharge. Overall, results suggest that ACT is a viable treatment option for individuals with eating pathology and further outcome research is warranted.

Treatment integrity is an important concern in treatment centers but is often overlooked. Performance feedback is a well-established approach to improving treatment integrity, but is underused and undervalued. One way to increase its value to treatment centers may be to expose unrealized benefits on the observer who collects the performance feedback data. This “observer effect” could increase the value of performance feedback and promote more consistent evaluation of treatment integrity. The purpose of this investigation was to evaluate the observer effect on treatment integrity. Five supervisors who worked in a day treatment center were asked to collect performance feedback data on staff members’ integrity in following a standard treatment protocol that supervisors were also expected to follow. Results showed an immediate and marked improvement in treatment integrity in three supervisors who collected but never received performance feedback. For two supervisors, this effect was reversed and replicated. Implications are discussed.

The goal of this study is to analyze the verbal interaction that takes place between client and therapist over the course of a clinical intervention so as to analyze the potential learning processes that may be responsible for changes in the client’s behavior. A total of 92 sessions were analyzed, corresponding to 19 clinical cases treated by 9 therapists specializing in behavioral therapy. The variables considered were therapist and client verbal behaviors, and these were categorized according to their possible functions and/or morphologies. The Observer XT software was used as a tool for the observational analysis. The results led to the conclusion that the therapist responds differentially to client verbalizations, modifying the verbal contingencies as his or her client content approaches or becomes more distant from therapeutic objectives. These results suggest the possible existence of verbal “shaping” processes through which the therapist guides the client’s verbal behavior toward more adaptive forms. In addition, this study proposes an alternative to the traditional controversy regarding the relevance of the therapeutic relationship versus the treatment techniques used to explain clinical change. This article suggests that such differentiation is unnecessary because the therapeutic relationship and the treatment techniques should act in the same manner, this is, in providing the context for the occurrence of what is truly therapeutic, namely, the learning processes.

The authors evaluated the effects of matched and unmatched stimuli on immediate and subsequent engagement in targeted vocal stereotypy (Experiment 1) and untargeted motor stereotypy (Experiment 2). Results of Experiment 1 showed that (a) matched stimulation decreased immediate engagement in vocal stereotypy for 8 of 11 participants and increased subsequent engagement in vocal stereotypy for only 1 of the 8 participants and (b) unmatched stimulation decreased immediate engagement in vocal stereotypy for only 1 of 10 participants and did not increase subsequent engagement in vocal stereotypy for this participant. Results of Experiment 2 showed that for 8 of 14 participants, untargeted stereotypy increased when the matched or unmatched stimulus was present, after it was removed, or both. The authors briefly discuss the potential clinical implications of using matched stimulation to decrease vocal stereotypy and limitations of the findings.

Fear of flying (FF) is an impairing psychological disorder that is extremely common in developed countries. The most effective treatment for this particular type of phobia is exposure therapy. However, there are few studies comparing imaginal exposure (IE) and virtual reality (VR) exposure for the treatment of FF. The present study compared the effectiveness of these two approaches using two manualized interventions based on the exposure technique. Patients with FF (N = 15) were randomly assigned to either VR (n = 7) or IE therapy (n = 8), consisting of a total of eight sessions: two assessment sessions (pre-treatment and after the real flight) and six exposure therapy sessions, which were conducted twice a week. During each exposure session, subjective perceived anxiety was measured every 5 min. Participants were also asked to sit through a real flight immediately after the treatment. The results showed no differences between the two treatments in relation to reduced clinical symptomatology associated with the FF, although participants in the VR group experienced less anxiety during the real flight after treatment. Furthermore, at 6-month follow-up, danger expectations and flight anxiety continued to decrease in participants who had received the VR exposure therapy, and four of these seven participants took at least one more flight.

A number of studies have shown that response interruption and redirection (RIRD) decreases immediate engagement in targeted stereotypic behaviors; however, its effects on untargeted stereotypy have not yet been studied, and its effects following removal of treatment are unclear. We evaluated the immediate and subsequent effects of RIRD on targeted motor stereotypy, as well as untargeted but higher probability vocal stereotypy, of two participants diagnosed with autism, using a three-component multiple-schedule design. Treatment with RIRD decreased immediate engagement in motor stereotypy for both participants, and did not increase subsequent engagement above baseline levels for either participant. In addition, RIRD produced modest changes in immediate engagement in untargeted vocal stereotypy for both participants. We briefly discuss the clinical implications and limitations of the findings from this study.