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| Novel Applications of Clinical Behavior Analysis: Fluency, Exposure and Adherence |
| Sunday, May 30, 2004 |
| 1:30 PM–2:50 PM |
| Conference Room 2 |
| Area: CBM/TPC; Domain: Applied Research |
| Chair: Blake M. Lancaster (Western Michigan University) |
| Discussant: Scott T. Gaynor (Western Michigan University) |
| Abstract: . |
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| Improving Blood Glucose Monitoring in Adolescents with Insulin-Dependent Diabetes Mellitus (IDDM) |
| STEPHEN J. ALBRECHT (Western Michigan University), Amy E. Naugle (Western Michigan University) |
| Abstract: Few studies have evaluated actual intervention strategies to improve treatment adherence among children and adolescents diagnosed with a chronic medical condition. Unfortunately, large numbers of patients do not adhere to their prescribed medical regimens (Lemanek, Kamps, & Chung, 2001). In diabetes populations, treatment nonadherence rates range anywhere from 30% to 80% (Johnson et al., 1982; Kovacs, Goldston, Obrosky, & Iyengar, 1992). Intervention strategies designed to improve treatment adherence can prevent, delay, or significantly reduce the risk of developing many negative health-related consequences (DCCT Research Group, 1994).
With the emergence of more effective medications and sophisticated medical technologies, many families are being asked to adhere to more complex and time-consuming medical regimens at home (La Greca & Schuman, 1995). Given the increased complexity of medical regimens, many researchers have concluded that more efficient and cost-effective intervention strategies are needed to enhance treatment adherence (Drotar & Lemanek, 2001). To date, intervention strategies relying on behavioral technology have obtained the most consistent treatment outcomes in improving treatment adherence (Gross et al., 1985; Rapoff, 1989; Rapoff, Purviance, & Lindsley, 1988). One disadvantage of behavioral intervention strategies is the relatively high level of physician, patient, and parental involvement required to effectively implement the interventions. Such labor-intensive procedures may not be the most efficient and cost-effective strategies to use in medical settings. Another effective and less time-consuming behavioral strategy that has not been widely applied in primary care settings is antecedent prompting procedures.
The current study targets nonadherence to blood glucose monitoring by using portable, automated paging technology. This pilot project is a work in progress. Using automated paging technology, patients are provided with external prompts to remind them to check their blood glucose levels. Antecedent prompting procedures using automated paging technology may be an effective way to remind adolescents to check their blood glucose levels. A series of single-subject case designs are being used to evaluate the effectiveness of the antecedent prompting procedure. It is anticipated that six adolescents with poorly controlled IDDM will be involved in this study. Treatment outcomes will be determined by visual inspection of the graphed data |
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| Conceptualization and Evaluation of Clinical Behavior Analysis Strategies within the Medical Model: Case Study of an Exposure Treatment for Panic Attacks |
| BLAKE M. LANCASTER (Western Michigan University) |
| Abstract: Behavioral approaches have begun to gain popularity and acceptance in many arenas such as schools, employee safety programs and language acquisition programs. There are, however, still settings in which behavioral theories have not yet been embraced consistently. One of these setting includes medical settings, where more traditional views of psychology, such as cognitive or psychoanalytic, are more commonly used to conceptualize behavioral or psychological issues. Within medical settings that do not subscribe to behavioral views, it is common for behavioral terms and conceptualizations to be interpreted as “simplistic” and claims that these techniques “do not address the real problems” are pervasive. The balance between implementing behavioral techniques and maintaining credibility in these medical settings is a difficult and evolving challenge for behavior analysts. Most of the difficulties that behavior analysts encounter in these medical settings revolve around the struggle to stay true to their behavioral principles while providing a comprehensive rationale for treatment to both colleagues and patients. Techniques and strategies that might be helpful in allowing the behavior analyst to exist effectively within a medical setting will be highlighted through the presentation of a anxiety case study (data based). The obstacles to conceptualizing and developing treatment protocols from a behavioral standpoint will be discussed in relation to the exposure protocol that was implemented for treatment. |
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| Fluency: A Potentially Important Concept for Clinical Behavior Analysis |
| JAY CLORE (Western Michigan University), Scott T. Gaynor (Western Michigan University), Amanda M. Harris (Western Michigan University) |
| Abstract: Fluent performance combines both accuracy and speed. Fluency training has proven to be effective basic academic skills, but has not caught on in some other areas of skill acquisition. Many empirically supported clinical treatments, such as cognitive behavior therapy (CBT) for depression, are heavily skills-based. That is, a focus of the therapy is providing the client with new skills (e.g., in confronting and challenging negative thoughts). However, such skills-based approaches have yet to incorporate the notion of fluency. Treating self-thoughts as we would any other behavior, we have been conducting a series of studies to see if fluency training can be used to increase individuals' frequency of, and contact with, adaptive self-thoughts. We began by establishing the base-rates of positive and negative self-thoughts among college students. We are now exploring the effects of training college students reporting low self-esteem to either (a) identify and change negative thoughts (via training and daily practice in a standard CBT technique) or (b) become more fluent in positive self-thoughts (via training and daily practice in conducting 1-min timings of positiveself-thoughts). The results may provide some preliminary information on important mechanisms of change in CBT and might suggest further use of fluency training in the clinic. |
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