|Building Durable Behavioral Treatments: Advancements In and Discussions On Relapse Mitigation and Clinical Implications
|Saturday, May 28, 2022
|12:00 PM–12:50 PM
|Meeting Level 2; Room 251
|Area: DDA/AUT; Domain: Translational
|Chair: Michael P. Kranak (Oakland University; Oakland University Center for Autism)
|Discussant: Daniel R. Mitteer (Rutgers University - Children's Specialized Hospital Center for Autism Research, Education, and Services)
|CE Instructor: Michael P. Kranak, Ph.D.
Behavioral treatments such as differential reinforcement are an effective means of reducing problem behavior. These treatments are frequently implemented by highly trained staff in well-controlled settings. After a clinically relevant reduction in problem behavior is achieved, these treatments are then transferred from clinics to the community (e.g., homes and schools), and from trained therapists to parents, caregivers, and other intervention agents. However, these treatments will be challenged during community implementation, potentially—and likely—leading to relapse (e.g., resurgence, renewal) and eventual treatment failure. Fortunately, researchers have developed some strategies to supplement behavioral treatments and improve their durability (i.e., able to withstand everyday challenges). In this symposium, the presenters will discuss common treatment challenges and their corresponding forms of relapse; as well as strategies practitioners can implement to improve the durability of their treatments. They will also describe relevant next steps for researchers in the area relapse and its mitigation. Following the presentations, audience members will be able to identify scenarios likely to result in relapse and ways in which they can mitigate relapse.
|Instruction Level: Intermediate
|Keyword(s): relapse, renewal, research-to-practice, resurgence
The intended audience is behavior analysts who have or currently work with individuals that engage in problem behavior, as well as researchers who work in the area of relapse. Audience members should be mildly familiar with relapse. However, presenters will provide some background and contextualization on various forms of relapse.
|Learning Objectives: At the conclusion of the presentations, participants will be able to: (1) identify areas of treatment provision that could result in relapse; (2) describe strategies for mitigating relapse; (3) demarcate the differences between various forms of relapse and their implications for treatment.
|On the Prospective Application of Quantitative Models in the Assessment and Treatment of Problem Behavior
|MICHAEL P. KRANAK (Oakland University; Oakland University Center for Autism), John Falligant (Kennedy Krieger Institute/Johns Hopkins University School of Medicine), Griffin Rooker (Mount St. Mary's University)
|Abstract: Behavioral treatments are effective in reducing problem behavior and equipping individuals with adaptive ways to communicate. However, these same treatments can lose their effectiveness in contexts where lapses in treatment integrity occur. These lapses in treatment integrity, both omission and commission errors, are two common treatment challenges that threaten long-term treatment gains. Although some recurrence of problem behavior and minor lapses in treatment integrity are expected, the risk of relapse of problem behavior increases as a function of increased recurrence of problem behavior and treatment integrity errors. In short, recurrence of problem behavior and treatment integrity errors can be the first steps in a chain that leads to eventual treatment failure. Quantitative models (e.g., Resurgence as Choice, behavioral momentum theory) have been an effort to better understand how challenges, such as lapses in treatment integrity, affect the durability of treatment. However, the extent to which these models are used in clinical practice is unknown. The presenter will (1) discuss recent findings on the application of quantitative models, (2) describe strategies for mitigating resurgence, and (3) review implications for clinicians and areas for researchers regarding durable treatments and behavioral inoculation.
|Six Things Practitioners Should Know About Renewal
|RYAN KIMBALL (University of Saint Joseph), Michael P. Kranak (Oakland University; Oakland University Center for Autism)
|Abstract: Individuals with and without developmental disabilities who engage in problem behavior receive treatment services in various settings such as their homes, schools, and clinics. These individuals also likely experience treatment provision from various practitioners such as therapists, teachers, and caregivers. Accordingly, changes in the treatment setting or intervention agent (i.e., context) will occur often and likely cause renewal. Renewal is the form of relapse that occurs when a previously eliminated behavior returns due to a change in context. The current paper describes six things practitioners should know about renewal. These reasons are the (1) distinction between renewal and another form of relapse (i.e., resurgence), (2) generality of renewal, (3) potential for renewal even when alternative reinforcement is available, (4) close relationship between renewal and the generalization of behavior change, (5) similarity between renewal testing procedures and situations that practitioners commonly encounter, and (6) variables that impact renewal and potential mitigation strategies. The current paper asserts that practitioners should prepare for renewal during context changes when working with their clients, especially during changes to the treatment setting or intervention agent. While discussion will be most relevant to practitioners, the paper also considers directions for future research on renewal in applied settings.