Jeffrey S. Webster

Visual scanning training with stroke patients

The present study examined the efficacy of the New York University visual scanning training program in treating patients with left-sided hemi-inattention and homonymous hemianoptic problems resulting from right hemispheric cortical lesions secondary to middle cerebral artery strokes. The study examined changes on a visual scanning task as well as generalization of training to obstacle course performances requiring the subjects to navigate their wheelchairs through a runway lined with chairs. Three male subjects were trained on the scanner in a stationary position and while they moved their wheelchairs. Progress was assessed using a multiple baseline across subjects design. Results revealed that all subjects showed systematic changes on the scanner task. Generalization of training to the obstacle course was more variable with one subject showing considerably fewer errors and the other subjects showing less impressive improvements in performance. A 1-year follow-up suggested that the scanning skill was maintained in all subjects. The need for adequate task analysis and training procedures which include all relevant cognitive/behavioral skills is discussed. In addition, the authors discuss the problems of attaining an adequate pretraining assessment of the brain-impaired subjects behavioral/cognitive repertoire.

Covert aversion of two interrelated deviant sexual practices: Obscence phone calling and exhibitionism. A single case analysis

The interrelationship among three distinct sexual behavior and arousal patterns (obscene phone calling, exhibitionism, and heterosexual arousal) were studied in an adult male. A multiple baseline design was used to evaluate the effects of covert sensitization on the two deviant patterns. Physiological and self-report of arousal to all three classes of sexual stimuli were taken throughout treatment, after discharge, and at 10-month follow-up. Results indicated that covert sensitization for obscene phone calling partially diminished arousal to the exhibitionistic stimuli, as well. When both deviant behaviors were treated, rapid and stable reductions in both physiological and self-report measures of deviant arousal were obtained, while arousal to heterosexual stimuli remained relatively high and essentially unchanged. Treatment gains were sustained during a 10-month follow-up period during which collateral reports revealed no other evidence of relapse. Additional findings included heart rate-penile tumescence changes consistent with an autonomic conditioning component model of covert sensitization.

Accuracy and controlling effects of self-monitoring as a function of concurrent responding and reinforcement*

Two experiments are presented in which the accuracy and controlling effects of self-monitoring are evaluated as a function of engaging in concurrent operants and as a function of being reinforced for reliable recording. In Experiment I, each of 12 subjects were exposed to conditions involving reinforced self-monitoring, operant responding, and the concurrent performance of operant responding and reinforced self-monitoring. Monitoring was always reinforced, operant responding was not. Results indicated that the accuracy of self-monitoring was decreased during the performance of a concurrent operant. No controlling (reactive) effects of self-monitoring were observed. Experiment II was conducted to evaluate the effects of reinforcing reliable self-monitoring on the accuracy and control produced by self-monitoring. Experimental phases included self-monitoring, reinforced self-monitoring, and a replication of concurrent reinforced self-monitoring-operant responding. Reinforcing reliable recording resulted in a slight decrease in errors compared to self-monitoring alone, while errors during both these conditions were significantly fewer than during the concurrent self-monitoring-operant task. Rates of the monitored response remained stable during reinforced self-monitoring, while they decreased during self-monitoring alone. The results of both experiments are related to the clinical usage of self-monitoring, as they demonstrate the importance of assessing concurrent environmental contingencies when requesting clients to self-monitor, as well as indicating the potential accelerative effects on a response that, when correctly monitored, is reinforced.

The effects of reinforcing concurrent behavior on self-monitoring

Each of 12 subjects served in three experimental conditions involving selfmonitoring of respiration, responding on a multiple FI 15″-VI 15″ schedule of reinforcement to produce steady states of lever pressing, and concurrent selfmonitoring and operant conditioning. Lever pressing was always reinforced, selfmonitoring was not. The percentage of self-monitoring errors more than doubled during the concurrent situation compared to self-monitoring alone. Increase in self-monitoring errors was associated with a decrease in response efficiency during VI schedule components. Also, self-monitoring was associated with decreased respiration rates, independent of increased monitoring errors. These results replicate the reactive effects of self-monitoring and indicate the importance of assessing the concurrent environmental demands when using self-monitoring as a treatment or in the evaluation of therapeutic effects.

A brief neuropsychological screening procedure that assesses left and right hemispheric function

Assessed the utility of two brief neuropsychological tests in screening patients referred to a neuropsychological consulting service. Forty-three cortically impaired and 19 neurologically intact Ss completed the Cognitive Capacity Screening Exam (CCSE) and the Memory-for-Designs (MFD). The results of these tests analyzed individually and in combination were compared with the Ss neurological reports. The analysis revealed that the combined system was significantly better than either single test in accurately detecting neuropathology. A closer look at the data suggests that the MFD was superior in identifying unilateral, right hemispheric damaged patients, while the CCSE was superior in identifying Ss with unilateral, left hemispheric damage. Results are discussed with reference to the difficulty in using single screening tests for detecting deficits that result from unilateral cortical dysfunction.

Progressive and Self-Induced Relaxation Training: Their Relative Effects on Subjective and Autonomic Arousal to Fearful Stimuli.

Compared progressive relaxation training (PRT), self-induced relaxation training (SRT), and a rest quietly (RQ) control condition on measures of tonic physiological arousal and phasic physiological and subjective reactions to fearful stimuli. The Mutilation Anxiety Questionnaire was used to identify 48 male and female participants for the two training assessment sessions. Evaluation of tonic reductions in sympathetic arousal indicated: In session one, PRT and SRT were equivalent; in session two, PRT was superior to SRT. Evaluation of subjective response to fearful stimuli favored PRT/SRT over RQ for low, moderately stressful stimuli; PRT was superior to SRT for the most stressful stimuli. An analysis of reported practice between sessions indicated a negative relationship between practice of relaxation skills and response to stressful tonic physiological arousal and attenuating subjective response to stressful stimuli. The interaction between the cognitive and physiological systems and its implication for therapy are discussed.

INSTRUCTIONAL, PACING, AND FEEDBACK CONTROL OF RESPIRATORY BEHAVIOR

Procedures designed to affect respiration rate and amplitude were assessed for 4 groups of 8 subjects each. The groups were exposed to combinations of procedures providing feedback for decreasing respiration amplitude, pacing respiration rate, and instructions on rate and amplitude of breathing. After an initial baseline, effects were examined during both treatment and self-management phases for respiratory activity and concurrent heart-rate and electromyogram activity. Reliable effects of pacing on respiration rate, and a slight, but non-significant effect on amplitude were observed. No effects were observed for any heart-rate or electromyogram measures.

The assessment of subjective tension levels among several muscle groups: The tension mannequin

The present paper introduces the Tension Mannequin, a self-report questionnaire on which tension levels of various muscle groups are rated. In Experiment 1 this instrument was administered to 44 normal adults preceding and following relaxation training. Questionnaire results revealed that subjects used three tension level ratings across muscles. Only 14% of the sample rated all muscle groups identically. Pre-training correlations between the individual muscle ratings and a general rating of tension suggested that the general rating was made by averaging tension in various muscle sites. The questionnaire appeared to be sensitive to the effects of relaxation training since pre- and post-comparisons of all muscle groups were significantly different. Experiment 2 investigated whether the questionnaire would differentiate subjects suffering at least three tension headaches per week from those reporting less than three. Results revealed that the frequent headache group had greater subjective tension in the forehead and neck. A case example illustrates how the Tension Mannequin revealed the importance of back discomfort to a patients experience of tension headaches and general tension.

An instrument to measure nurses knowledge of behavioral methods with chronic pain patients

A 32-item multiple-choice questionnaire is described to assess nurses knowledge of behavioral methods with chronic pain patients. The instrument was designed to assess knowledge across four areas: (a) behavioral principles, terms, and facts about pain patients, (b) application of behavioral methods to decrease negative pain behavior, (c) application of behavioral methods to increase positive well behavior, and (d) when, and with which pain patients to apply behavioral methods. Factor analyses identified two basic factors measured by the instrument. These included general knowledge of behavioral methods with chronic pain patients and the ability to differentially apply these methods in various medical circumstances. Further analysis revealed that the instrument contained adequate internal consistency, reliability and validity.

Comparison of Stimulus Control and Reinforcement Control Effects on Imitative Behavior.

Abstract An attempt was made to evaluate reinforcement and stimulus control of imitative and non-imitative behavior. The imitative response required the subject to duplicate the experimenters response by matching blocks that varied in color. The factor designed to evaluate stimulus control was fading, a procedure that systematically varies the differences between the imitative and non-imitative stimuli. The topography and duration of the non-imitative stimuli were faded in. The factors designed to evaluate reinforcement control were differential reinforcement of non-imitative behavior and time out from positive reinforcement. The results showed stimulus control of non-imitation to be more important than reinforcement control, and that reinforcing events were not sufficient to control non-imitation; while the arrangement of stimulus events was sufficient to control non-imitation. These results were related to studies providing evidence for the processes of discrimination and generalization.