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Psychotherapy and bulimia nervosa. Longer-term effects of interpersonal psychotherapy, behavior therapy, and cognitive behavior therapy.

OBJECTIVE: To determine whether cognitive behavior therapy (CBT) for bulimia nervosa has a specific therapeutic effect and determine whether a simplified behavioral treatment (BT) of CBT is as effective as the full treatment. DESIGN: Randomized controlled trial involving three psychological treatments. Two planned comparisons, CBT with interpersonal psychotherapy (IPT), and CBT with BT. Closed 12-month follow-up period. Independent assessors. SETTING: Secondary referral center. PATIENTS: Seventy-five consecutively referred patients with bulimia nervosa. Patients with concurrent anorexia nervosa were excluded. INTERVENTIONS: Cognitive behavior therapy, IPT, BT conducted on an individual outpatient basis. There were nineteen sessions over 18 weeks. Six experienced therapists administered all three treatments. There was no concurrent treatment. MAIN OUTCOME MEASURE: Frequency of binge eating and purging. RESULTS: High rate (48%) of attrition and withdrawal among the patients who received BT. Over follow-up, few patients undergoing BT met criteria for a good outcome (cessation of all forms of binge eating and purging). Patients in the CBT and IPT treatments made equivalent, substantial, and lasting changes across all areas of symptoms, although there were clear temporal differences in the pattern of response, with IPT taking longer to achieve its effects. CONCLUSIONS: Bulimia nervosa may be treated successfully without focusing directly on the patient's eating habits and attitudes to shape and weight. Cognitive behavior therapy and IPT achieved equivalent effects through the operation of apparently different mediating mechanisms. A further comparison of CBT and IPT is warranted. The behavioral version of CBT was markedly less effective than the full treatment.

Adolescent↗

Linguistic analogies and behavior: the finite-state behavioral grammar of food-hoarding in hamsters.

Rodger and Rosebrugh (1979) developed a method for identifying sets of rules by which discrete responses are combined to form functional sequences of behavior. In the present study, this so-called finite-state behavioral grammar method was used to analyze the food-hoarding behavior of Syrian golden hamsters (Mesocricetus auratus). Specifically, it was used to analyze 127 videotaped food-hoarding sequences that were observed in 14 male, adult hamsters in an apparatus that comprised a home compartment, a foraging area, and a connecting tunnel. An integral part of grammar derivation is the development of hypotheses about the function of the observed response patterns to guide the grammar derivation. Two such hypotheses guided the present analysis: first, we hypothesized that behaviors observed in the foraging area after the hamsters' cheek pouches were filled served an exploratory function; second, we hypothesized that behaviors observed in the home compartment prior to the hamsters emptying their cheeck pouches served to assess potential food deposition sites. In addition to generating these two hypotheses and the grammars for the hoarding sequences, this study demonstrates how the finite-state grammar method can be used as a productive means of gaining insights into the organization of consummatory response sequences.

Animals↗

The alliance of adaptive behavior and social competence: an examination of relationship between the scales of Independent Behavior and the Social Skills Rating System.

This study examined the relationship between ratings of adaptive behavior and social competence in a population of 208 students in kindergarten through third grade with a variety of disabilities using the Scales of Independent Behavior (SIB; Bruininks, Woodcock, Weatherman, & Hill, 1984) and the Social Skills Rating System (SSRS; Gresham & Elliott, 1990). Moderate yet statistically significant relationships between the SIB adaptive behavior scores and the SSRS social competence scores were found, with strongest correlations occurring between the SSRS and the Social and Communication subscale (r = .51) and Work Skills subscale (r = .60) on the SIB. Weak to near zero correlations were found between the SIB adaptive behavior scores and SSRS Problem Behaviors scores. This investigation provides new evidence for the concurrent criterion-related validity of both the SIB and the SSRS.

Activities of Daily Living↗

Pharmacological manipulations of food protection behavior in rats: evidence for dopaminergic contributions to time perception during a natural behavior.

Operant procedures combined with pharmacological manipulations have implicated a role for the dopaminergic system in the perception and production of temporal intervals. Because studies have suggested that animals use temporal information to organize food protection behavior, the current study investigates whether dopaminergic systems are involved in timing during this natural behavior. The experiment examined the influence of a dopaminergic agonist (amphetamine) and an antagonist (haloperidol) on food protection behavior initiated to avoid theft by a conspecific. Amphetamine increased the time spent dodging and decreased the time spent bracing during the consumption of a hazelnut. On the other hand, haloperidol decreased the time spent dodging while showing no systematic changes in bracing. Topographic and kinematic analyses of rat movement conflicted with motivational, motoric, and social accounts of drug-induced changes in food protection behavior organization. These observations provide evidence that rats use temporal information to organize movements in the natural behavior of protecting food from theft by a conspecific, and this organization is influenced by both a dopaminergic agonist and an antagonist.

Agonistic Behavior↗

Relevance of functional behavioral assessment research for school-based interventions and positive behavioral support.

The Individuals With Disabilities Education Act (IDEA) Amendments of 1997 mandate the use of functional behavioral assessment (FBA) and positive behavioral supports and interventions for students with disabilities. Although much progress has been made in our understanding of functional analysis over the past 15 years, the extent to which these findings can be generalized across clients, methods, settings, and response classes is unknown. This article reviewed 150 school-based intervention studies conducted with children published in the Journal of Applied Behavior Analysis from 1991 to 1999. Fifty-two percent of these intervention studies did not report using FBA information linked to the intervention. Interventions based on descriptive, experimental, or combined FBA procedures were no more effective than interventions in which no FBA information was provided. With respect to positive behavioral support, over half of the studies targeted appropriate behaviors with two-thirds of them using a combination of antecedent- and consequence-based interventions. Recommendations are made for conducting fundamental research on reliability and validity issues in FBA and determining when, how, and under what conditions FBA procedures are most appropriate.

Adolescent↗

Site and behavioral specificity of periaqueductal gray lesions on postpartum sexual, maternal, and aggressive behaviors in rats.

Bilateral electrolytic lesions of the lateral and ventrolateral caudal periaqueductal gray (cPAGl,vl) of lactating rats are known to severely reduce suckling-induced kyphosis (upright crouched nursing), which is necessary for maximal litter weight gains, and impair sexual behavior during the postpartum estrous, while heightening nursing in other postures and attacks on unfamiliar adult male intruders. In the present report, the site specificity of the cPAG with respect to the control of these behaviors was determined by comparing lesions of the cPAGl,vl with similarly sized lesions within the rostral PAG (rPAG) and surrounding mesencephalon. The previously seen effects of prepartum cPAGl,vl lesions on kyphotic nursing, sexual proceptivity and receptivity, maternal aggression, and daily litter weight gains were replicated. Additionally, the post-lesion facilitation of aggression was found to be behaviorally specific, first by being directed toward an adult, but not to a nonthreatening juvenile male rat, and second, by requiring the recent presence of the pups, being eliminated or decreased 24 h after removal of the litter. Damage to the rPAG did not affect nursing or sexual behaviors, and had only a minimal effect on maternal aggression. Lesions of the rPAG, however, greatly impaired the dams' ability to rapidly release pups held in the mouth, but not to pick them up or carry them directly to the nest during retrieval. Separate regions of the PAG, therefore, are differentially involved in the control of specific components of behaviors in lactating rats.

Aggression↗

A behavioral intervention for improving verbal behaviors of heroin addicts in a treatment clinic.

Positively reinforcing appropriate behaviors improved verbal behaviors of opioid-dependent patients in a buprenorphine treatment clinic. During B phases of an ABAB design, clients received stickers for engaging in appropriate verbal or nonverbal behaviors. Each sticker provided a chance of winning $25. No reinforcement was provided during the A phases. Appropriate verbal behaviors increased during reinforcement periods, and inappropriate verbal behaviors decreased.

Adult↗

Behavioral profile of Alzheimer's disease in Chinese elderly--a validation study of the Chinese version of the Alzheimer's disease behavioral pathology rating scale.

OBJECTIVES: This study aims to examine the psychometric properties of the Chinese version of the Alzheimer's disease behavioral pathology rating scale (CBehave-AD) and the behavioral profile of Chinese patients with AD. METHODS: Seventy-one subjects with NINCDS-ADRDA diagnosis of probable and possible AD were assessed for validation of the CBehave-AD. A behavioral symptom frequency checklist, the Chinese version of the Blessed Roth dementia scale (CDS) and the Cantonese version of the Mini-Mental State Examination (CMMSE) were used for comparison. An extended sample of 120 AD patients was then evaluated with the CBehave-AD. RESULTS: High correlations between the CBehave-AD and checklist scores were found (paranoid and delusional ideation, hallucinations, activity disturbances, aggressiveness and diurnal rhythm disturbances). The scale also demonstrated satisfactory inter-rater and test-retest reliabilities. The mean (SD) CMMSE score of the 120 patients was 9.4 (7.1). Among them, 32% have delusions, 15% had hallucinations, 54% had activity disturbances, 61% had aggressive behavior, 44% had sleep disturbance, 24% had affective disturbances, 19% had anxiety and phobias. Delusional ideation was significantly associated with hallucinations, aggressiveness, and affective disturbances. Diurnal rhythm disturbances were associated with activity disturbances and aggressiveness. CBehave-AD total scores were not significantly correlated with severity of AD, but individual symptom categories showed different pattern of correlation. Delusions, hallucinations, anxiety and phobias were significantly correlated with dementia staging. CONCLUSION: The findings suggest that the CBehave-AD is a valid assessment tool for behavioral disturbances in patients with AD. Variable associations between different symptom categories and dementia staging suggest a need for further exploration of the complex interactions between behavioral and cognitive disturbances in dementia.

Aged↗

The behavioral neurobiology of self-injurious behavior in rhesus monkeys.

1. Self-injurious behavior (SIB) is prevalent among institutionalized children, but the efficacy of current behavioral and pharmacological treatments is marginal. 2. There is evidence that SIB in humans has a neurobiological basis. A better understanding of the neurobiological factors that may promote or cause SIB is necessary for the development of effective pharmacologic treatments. 3. SIB that is similar in some respects to SIB in humans occurs in nonhuman primates that have been deprived of social experience early in life. An analysis of the "cause" of SIB suggests that it is a relatively straight-forward example of the development of neurobiological and behavioral aspects of aggressive behavior in the absence of social factors that would normally bring the behavior under environmental control. Once induced, however, it becomes environmentally autonomous and its proximal cause is neurobiological in nature. 4. There are three lines of evidence that nonhuman primate SIB is linked to malfunctions in the norepinephrine (NE) and serotonin (5HT) neurotransmitter systems. The activity of these systems appears to be altered by psychosocial deprivation. The functional relationship between the two systems appears to be altered or absent in socially deprived monkeys. Pharmacologic agents that act on these systems alter SIB in monkeys. 5. Preliminary data from socially deprived rhesus monkeys are consistent in major respects with studies linking altered serotonin systems to self-injurious behavior and suicidal motivation in humans who also probably suffer from social deprivation. 6. Taken together, these findings indicate that developmental study of biogenic amine systems, particularly finding ways to circumvent deficits in, or restore functional linkages between, the 5HT and NE systems, will lead to a greater understanding of the neurobiologic basis of SIB in humans and animals and will enable us to develop more effective treatments of SIB.

Aggression↗

Recovery of function after brain damage: differential effects of blocking calcium uptake during the recovery of a learned behavior and the performance of the recovered behavior following neocortical brain injury.

The recovery of a learned behavior following brain damage is typically considered to have occurred when the brain-injured individual reattains the performance criterion that defined original preoperative learning. While this is obviously correct from an operational point of view, it does not necessarily mean that the consequences of the brain injury have been reversed, particularly with regard to the sustained performance of the supposedly recovered behavior. The present research attempted a more comprehensive evaluation of the behavioral effects of localized neocortical injury by investigating how a calcium channel blocker would effect (a) the original preoperative acquisition, (b) the initial postoperative recovery, and (c) the subsequent long-term performance of a brightness discrimination learned by rats subjected to injuries of their visual neocortex. The results demonstrated that notwithstanding the brain-injured rat's ability to reattain the performance criterion used to define preoperative learning, its long-term performance of this recovered behavior was significantly inferior to that of a normal rat. More importantly, the present data suggest that there are important differences between the initial postoperative recovery of a behavior and its long-term performance since the same drug that will facilitate initial recovery has just the opposite effect with respect to the animals long-term postoperative performance of the behavior.

Analysis of Variance↗

Co-occurrence of aggressive behavior and rule-breaking behavior at age 12: multi-rater analyses.

Aggressive Behavior (AGG) and Rule-Breaking Behavior (RB) are two of the eight CBCL syndromes. The phenotypic correlation between AGG and RB ranges from.48 to.76, and varies depending on the rater and the sex of the child. Prevalence of AGG and RB (i.e., T > or = 67) is in the range of 6%-7% in both boys and girls. Fifty percent to 60% of the children who are deviant on AGG are also deviant on RB and vice versa. Why so many children show problem behavior in the clinical range for both syndromes is unclear. This co-occurrence could be due to genetic factors influencing both traits, to environmental factors influencing both traits, or to both. The purpose of this study is to use a genetically informative sample to estimate genetic and environmental influences on AGG and RB and to investigate the etiology of the co-occurrence of both behaviors. We do this using multiple informants to take into account underlying sources of parental agreement and disagreement in ratings of their offspring. To this end, mother and father ratings of AGG and RB were collected by using the Child Behavior Checklist in a large sample of 12-year-old twins. Parental agreement is represented by an interparent correlation in the range of .53-.76, depending on phenotype (AGG or RB) and sex of the child. Genetic influences account for 79% and 69% of the individual differences in RB and AGG behavior (defined as AGG and RB on which both parents do agree) in boys. In girls 56% and 72% of the variance in RB and AGG are accounted for by genetic factors. Shared environmental influences are significant for RB in girls only, explaining 23% of the total variance. Eighty percent of the covariance between AGG and RB, similarly assessed by both parents, can be explained by genetic influences. So, co-occurrence in AGG and RB is mainly caused by a common set of genes. Parental disagreement seems to be a combination of so-called rater bias and of parental specific views.

Aggression↗

A developmental-genetic analysis of aggressive behavior in mice (Mus musculus): III. Behavioral mediation by heightened reactivity or immobility?

This research was designed to investigate development and behavioral mediation in lines of ICR mice that have been selectively bred for aggressive behavior. General behavioral reactivity and behavioral immobility have been implicated as potential mediators by prior analyses of preattack interactions. To evaluate the separate roles of these dispositions, the emergence of attacks in genetically selected lines was tracked for 11 years by three levels of analysis: over successive generations, over development, and over dyadic interactions. Convergent outcomes were observed in all three levels with respect to two findings: (a) Robust line differences were obtained in attack behaviors, and (b) strong associations were found between line differences in attacks and line differences in behavioral immobility. Conversely, all three levels of analysis indicated a weak and inconsistent association between line differences in attacks and measures of social and nonsocial reactivity.

Aggression↗

Chronic illness behavior in psychiatric patients: an attempt at behavioral validation.

Recent literature has focused on chronic illness behavior as a final common pathway for many patients with psychosomatic disorders and learning theory has been used to explain the behaviors of these patients. The present study evaluated psychiatric patients in a variety of treatment settings using the methodology of Wooley and Blackwell (1). Blank forms were used as "do it yourself" tokens and rewarded behaviors were categorized as care-taking, sociability, achievement, communication, or other. A multivariate analysis of variance revealed that psychiatric patients did not differentially reward care-taking, as a chronic illness model would have anticipated; rather, they most frequently rewarded socialization and achievement. In addition, we found that patients without disability compensation rewarded socialization more frequently and achievement less frequently than did those patients with compensation. Treatment setting was not related to the types of behaviors that were rewarded. This study does not support a behavioral theory of chronic illness behavior in a general psychiatric population. The results are discussed with respect to the implications for psychiatry and psychosomatic medicine.

Achievement↗

Effects of reinforcing increases in active behavior versus decreases in sedentary behavior for obese children.

This experiment tested the effects of reinforcing obese children lo be more active or less sedentary in their choice of active versus sedentary behaviors. On days I and 5, there were no contingencies for sedentary or active behaviors. During days 2 through 4, children in the Activity group were reinforced for being more active, and they significantly increased their activity and decreased time spent on preferred sedentary activities. Children in the Sedentary group were reinforced for not engaging in preferred sedentary behaviors, and they significantly decreased time spent on these sedentary behaviors, with lime reallocated both to being more active and to substitution of lower preference sedentary behaviors. Children randomized to the Control group were reinforced for attendance and made choices among the alternatives as usual, allocating most or their time during all 5 days for their preferred sedentary behaviors. These laboratory results support the idea that activity can be increased by either reinforcing children for being more active or for reducing lime spent in sedentary activities.

Journal Article↗

Behavioral self-control of on-task behavior in an elementary classroom.

Techniques of behavioral self-control were employed in a class where a high level of on-task behavior had been established with externally administered reinforcement procedures. The behavioral self-control techniques maintained behavior at its ongoing high level both immediately following the externally administered reinforcement treatments and during follow-up treatments after five and seven weeks. Variability in on-task behavior was reduced during the behavioral self-control phases of the study.

Journal Article↗

[Prediction of goal-directed behavior: attitude, subjective behavioral competence and emotions].

Ajzen's (1985) theory of planned behavior explaining and predicting goal-directed behavior is extended by an emotional component. The extended theory of planned behavior is tested experimentally. N = 64 subjects play with two video games (a speed- and a problem-oriented game) under an achievement-motivational orientation. One half of the subjects plays both games in an easy version, the other half in a difficult version. The verbal emotional reactions to playing video games are grouped factor-analytically into an "activity emotion" and a "security emotion". Subjects playing video games in the difficult condition feel significantly more insecure, and perceive their behavioral control as significantly lower than subjects playing in the easy condition. Tests of the extended theory of planned behavior lead to significant squared multiple correlations for the dependent variables within the range of R2 = .20 to .58. The activity emotion accounts predominantly for a significant part of the variance of the attitude and the security emotion accounts for a significant part of the variance of the perceived behavioral control. No predictive power was found for the intention to play the games successfully.

Achievement↗

Sexual function in depressed men. Assessment by self-report, behavioral, and nocturnal penile tumescence measures before and after treatment with cognitive behavior therapy.

Clinicians have long associated depression with alterations in sexual function, predominantly loss of sexual interest. In a longitudinal study measuring self-report, behavioral, and nocturnal penile tumescence variables before and after treatment with cognitive behavior therapy in an unmedicated sample of 40 outpatient depressed men, we found, contrary to expectation, that sexual activity per se was not reduced during the depressed state. Rather, loss of sexual interest appeared to be related to the cognitive set of depression, ie, loss of sexual satisfaction that then improved with remission from depression. Depressed men were heterogeneous, however, with respect to sexual behavior, eg, an anxious and more chronically depressed subgroup of men who did not have remissions with cognitive behavior therapy reported increased sexual interest and sexual activity. Also, contrary to expectation, nocturnal penile tumescence abnormalities in depressed men did not reverse when measured in early remission, nor did nocturnal penile tumescence measures correlate significantly with behavioral measures of sexual function. Nocturnal penile tumescence alterations in depression may thus be similar to other persistent electroencephalographic sleep abnormalities seen in depressed patients in remission, in being more trait-like than statelike.

Adult↗

Behavioral profiles of adult rats in a difficult food supply social situation, related to certain early behavioral features.

Behavioral profiles of male rats were defined in nine intralitter groups of six individuals at various stages of their development: (a) at pup stage in individual situations (uncomfortable positions) and social situations (removal away from the mother), and (b) at adult stage in a difficult food supply social situation (complete immersion of the food access way). The male population was split into two sets, both at pup stage (the most and the least swift and efficient of each group to overcome uncomfortable situations), and at adult stage (carriers and noncarriers of food in each group tested). Our results showed an important relation between these pup and adult behavioral profiles: the swiftest and most efficient individuals of a group at pup stage adopted more often a food carrier behavioral profile at adult stage. Assumptions about the predictive value of some behavioral features of a young rat in regard to its adult behavioral profile are discussed.

Aging↗