Philip H. Bornstein

Consumer satisfaction in adult behavior therapy: Procedures, problems, and future perspectives

Until recently there has been very little interest in assessing client satisfaction regarding the delivery of adult behavior therapeutic services. Given this preeminent finding, relevant literature is reviewed with respect to: levels of satisfaction, comparisons with other approaches, comparisons within behavior therapy, satisfaction/outcome in behavior therapy, and acceptability of behavioral treatment procedures. Methodological and research-related questions are addressed. These include psychometric considerations, comparative analyses, reported levels of satisfaction, and global satisfaction versus component evaluation. Alternative strategies for the measurement of consumer satisfaction are discussed. Among these options are the utilization of solicited/unsolicited comments, unobtrusive measures, archival records, consumer dissatisfaction information, continuous measures of satisfaction, goal attainment scaling, and survey methods.

Treatment of Sleep Onset Insomnia by Paradoxical Instruction A Multiple Baseline Design

Four adult outpatients suffering from severe, chronic sleep onset insomnia participated in a five-session paradoxical instruction treatment program. A multiple baseline design across subjects was utilized with major dependent measures consisting of eight behaviorally-specific daily sleep indices. Counterdemand manipulations were applied so as to evaluate and control for change attributable to expectancy and therapeutic demand. Results indicated significant improvement on five of the daily sleep chart measures, with treatment gains maintained at 4-, 8-, and 12-week follow-up. These findings are discussed with regard to interruption of hypothesized exacerbation cycle phenomenon.

Multi-component behavioral treatment of trichotillomania: A case study

Abstract A 21-year-old female with a 13-year history of compulsive hair pulling was treated via a multi-component behavioral intervention strategy. Dependent variables included both quasi-direct behavioral frequency counts (i.e., number of hairs pulled) and physical trace, natural erosion measures (i.e. size of bald areas). Results indicated dramatic decrease in number of hairs pulled from treatment through 40 weeks post-initiation of baseline. These findings were discussed with regard to situational-specificity of trichotillomania and reliance upon experimenter-derived rather than subject-controlled data collection sources.

Paradoxical instruction in the treatment of encopresis and chronic constipation: An experimental analysis

The purpose of the present single-case experimental investigation was to examine the efficacy of paradoxical instruction in the treatment of exacerbation-based discontinuous encopresis and chronic constipation. The subject, a 9-yr old male, complained of infrequent bowel movements and daily soiling. In addition, toileting and related activities appeared to cause considerable anxiety. An ABAB reversal design with 1-yr follow-up was used as a means of evaluating treatment effectiveness. Dependent measures included weekly parental records of soiling and appropriate bowel movements. Results indicated a clear demonstration of functional control and consistent improvement in the encopretic disturbance. These findings were maintained at 1-yr follow-up.

Treatment of insomnia by paradoxical intention: A time-series analysis

Paradoxical instructions were presented to an individual suffering from chronic insomnia. To control for improvement attributable to demand characteristics alone, counterdemand manipulations were utilized during the treatment period. Results, analyzed via time series analysis, indicated significant improvement on five of eight self-recorded sleep dimensions. These findings were discussed with regard to the hypothesized interruption of the “exacerbation cycle”.

A social learning rationale and suggestions for behavioral treatment with American Indian alcohol abusers.

Abstract Social learning theory postulates that modeling of overt behavior and the individuals cognitive representation of his/her behavior are two factors causally related to ones actions. Four factors are identified as central to alcohol abuse among American Indians: (a) rapid consumption of alcohol; (b) outmoded models of prolonged intoxication; (c) non-responsibility for intoxicated behavior; and (d) the peer drinking group. It is demonstrated that each of these four factors can be adequately accounted for using a social learning theory paradigm and consequently addressed within a behavioral treatment program.

Interpersonal Skills Training: Evaluation of a Program with Adult Male Offenders.

In order to assess the efficacy of an interpersonal skill training program with adult offenders, 14 males presently serving terms in Montana State Prison were randomly assigned to one of the following conditions: (a) interpersonal effectiveness training or (b) waiting-list control. The interpersonal effectiveness training group met for six one-hour sessions during which time inmates rehearsed, modeled, and were coached in generating appropriate responses to socially problematic conflict situations. Dependent measures, administered pre- and posttreatment, included the Personality Research Form (PRF), S-R Inventory of Anxiousness (SRIA), and Interpersonal Behavior Role-Play Test (IBRT). Major results indicated interpersonal effectiveness training group superiority on IBRT training and generalization assessment items (ps<.01). These findings were discussed with regard to the establishment of effective coping strategies both within correctional and natural environments.

Behavior Modification by Long-Distance Demonstration of Functional Control Over Disruptive Behavior in a Rural Classroom Setting

A nine-year-old male was treated with a positive practice procedure for inappropriate out-of-seat behavior in the classroom. Because both subject and teacher lived in an isolated rural environment, professional involvement was unavoidably restricted to a long-distance consultation-type format. Contingencies were applied by the subjects teacher and results were evaluated by means of a single-subject reversal design. Introduction and removal of the positive practice procedure appeared to have a clear and systematic effect upon the frequency of target behavior occurrence. More-over, behavioral improvements were maintained three and one-half months following a Positive Practice-Matching condition in which the subject self-monitored, matched, and earned group rewards for the entire class. These results were discussed with regard to problem-specific consultation and the situational constraints often imposed by rural environments.

Reliability Enhancement: Increasing the accuracy of self-report through mediation-based procedures

Eighteen subjects, self-referred for tension and anxiety, were randomly assigned to either a Reliability Enhancement Package (composed of cognitive consistency, consequence clarification, public commitment, and cueing manipulations)or an Attention-Control condition. Subjects in both groups received anxiety-oriented treatment in the form of progressive relaxation training. A pre- and posttreatment bogus biofeedback assessment was conducted during which time subjects self-recorded “time in alpha” as a supposed measure of their relaxation abilities. Experimental procedures (i.e., REP and AC)were administered prior to the posttreatment assessment session. Self-recorded alpha records were then compared to external ratings in order to assess the accuracy of self-report data. Results indicated significantly greater inaccuracy scores at posttreatment for Attention-Control as compared to Reliability Enhancement subjects (p < .005).Moreover, errors committed were in the direction of overestimating time in alpha (p < .02).These results were discussed with regard to mediational manipulations and expanding self-observational research strategies.

Behavioral Marital Bibliotherapy: An Initial Investigation of Therapeutic Efficacy.

Abstract The present study reports an attempt to validate a self-help behavioral marital bibliotherapy program. Five clinical distressed couples were evaluated via a multiple baseline analysis. Dependent measures included both pre-post and continuous forms of assessment. Treatment involved the weekly introduction of both reading and exercise material. Topics included communications, problem solving, sexual dysfunction, maintaining relationship gains, etc. With the exception of a decrease in laboratory-assessed negative behaviors, results were highly variable and generally reflective of minimal change. These findings were discussed with regard to measurement failure, manipulation of the independent variable, and continued examination of marital self-help materials.