R. Wayne Fuqua

Habit reversal with muscle tics: Replication and component analysis

Habit reversal, a multicomponent treatment package, was compared with a simplified package consisting of just two components, awareness and competing response training, in the treatment of muscle tics. Nine subjects with various muscle tics were divided into two treatment groups. Awareness and competing response training was introduced for five subjects in a multiple baseline across subjects design. Using a similar design, four subjects were exposed to the entire habit reversal package. Objective measures of tics were attained by videotaping subjects under clinic conditions designed to evoke their respective tic. The results indicated that the awareness and competing response training was as effective in decreasing tic frequency as the whole habit reversal program. One subject with severe torticollis failed to benefit from the habit reversal. All other subjects in both groups showed marked improvement which was maintained at brief follow-up.

Effects of a multicomponent intervention on motivation and sun protection behaviors among midwestern beachgoers

Skin cancer is the most prevalent of all cancers in the United States. Although avoiding sun exposure and using sun protection reduces skin cancer risk, rates of such behaviors are moderate at best. The present study examined the impact of a multicomponent intervention that aimed to increase the saliency of skin cancer risk while promoting the use of sun protection. Midwestern beachgoers (n = 100) participated in an intervention or questionnaire-only control group. Sun protection, stage of change, and sun exposure were measured at baseline and 2-month follow-up. The intervention group significantly improved in sun protection use and stage of change, but not sun exposure, compared with the control group. Personalizing the risks of unprotected sun exposure combined with providing education about sun protection facilitated healthy changes in behavior and motivation.

A comparison of contingent vs non-contingent competing response practice in the treatment of nervous habits

Previous research found that two components of the habit reversal procedure, the practice of a competing response (CR) and awareness training, suppressed muscle tics to the same degree as Azrins entire habit reversal program. This study compared the effectiveness of two variations of the competing response procedure (contingent vs non-contingent practice) on the nervous habits of nine subjects. The results showed the non-contingent competing response to be largely ineffective in decreasing the target behaviors. The contingent competing response procedure greatly reduced the nervous habits of most subjects, and the complete habit reversal procedure further decreased the behavior for two subjects. This research indicates that the competing response procedure is most effective when used in a contingent fashion.

Eliminating selective stimulus control: A comparison of two procedures for teaching mentaly retarded children to respond to compound stimuli☆

Selective stimulus control occurs when behavior fails to come under control of all characteristics of a compound stimulus after discrimination training. Two different assessment procedures, one used in prior research and the other incorporating incorrect stimuli (S - s) which differed minimally from the correct stimulus (S+), were used to detect stimulus control deficits characteristic of selective stimulus control. The efficacy of two training procedures in eliminating selective stimulus control observed with three trainable mentally retarded children was evaluated in Experiment 1. A training procedure using S - s that were minimally different from the S+ was designed to reduce the probability that stimulus discriminations could be based on stimulus characteristics other than experimenter-specified characteristics defining the S+. This procedure proved more effective in preventing and eliminating selective stimulus control as measured by both assessment procedures than an alternate discrimination training procedure that failed to impact the more stringent measures of selective stimulus control. Experiment 2 indicated that these improvements in stimulus control were not a function of varying degrees of difficulty between stimulus sets or of a prior history of discrimination training with the less effective training procedure. The need for better assessment procedures to detect selective stimulus control and suggestions for further improvements in discrimination training procedures are discussed.

Trichotillomania: Conceptualization, measurement, and treatment

Trichotillomania (TCM), a condition characterized by chronic hair pulling, has received increased attention in the behavioral literature of late. Because TCM has typically been conceptualized as a psychiatric, rather than a behavioral, psychological, or pediatric concern, behavior therapists may have little background information about the disorder and its treatments. This paper presents a review of the nature of TCM and the current conceptualizations of the disorder. We review recent research on the measurement and treatment of TCM. Limitations of the current research, suggestions for further study, and implications for treatment of TCM are discussed.

Evaluating the Social Acceptability of Persons with Habit Disorders: The Effects of Topography, Frequency, and Gender Manipulation

In this study, 120 undergraduate students were asked to rate the social acceptability of a male and female who portrayed different habit behaviors (motor tics, vocal tics, Tourettes disorder, and trichotillomania). The portrayals of these behaviors were clinically valid as viewed by mental health professionals. Each habit behavior was portrayed in a variety of frequency/topography combinations including low frequency/mild topography, low frequency/severe topography, high frequency/mild topography, and high frequency/ severe topography. Participants were randomly assigned to one of four habit conditions (motor tic, vocal tic, Tourettes disorder, and trichotillomania) and were asked to rate the social acceptability of the frequency/topography combinations exhibited by each actor. Results showed that across the various habit conditions, the man with the habit was seen as less socially acceptable than the woman with the habit. In addition, low-frequency habit behaviors were more acceptable than high-frequency behaviors, and behaviors with mild topographies were more acceptable than those with severe topography habits. Motor tics were seen as more acceptable than vocal tics, Tourettes disorder, or trichotillomania. Implications and directions for future research are discussed.

Comparing the effectiveness of similar and dissimilar competing responses in evaluating the habit reversal treatment for oral–digital habits in children

In the present study 26 children with chronic oral-digital habits were randomly assigned to 1 of 3 conditions. Group 1 received habit reversal using a similar competing response. Group 2 received habit reversal using a dissimilar competing response, and Group 3 served as a wait-list control group. Three videotaped observations were taken at pretreatment and again at posttreatment. In addition, social acceptability data were collected on the treatment groups at posttreatment. Results showed that the similar and dissimilar groups were engaging in significantly less oral-digital behavior at posttreatment when compared to the control group. However, the two treatment groups did not differ from each other in terms of treatment gains or acceptability. These results suggest that habit reversal is an effective treatment for oral digital habits in children. In addition, it appears that the competing response does not function as a physically incompatible behavior. Implications of the findings are discussed.

Rumination and vomiting in the developmentally disabled: A critical review of the behavioral, medical, and psychiatric treatment research

Medical and psychiatric research regarding the treatment of vomiting and rumination among developmentally disabled individuals was selectively reviewed. Because of serious methodological flaws which pervade the psychiatric literature, claims for the effectiveness of psychiatric interventions for vomiting and rumination cannot be justified. Medical interventions (e.g., pharmacological and surgical interventions) were found to be effective when rumination was attributable to a specific organic pathology. In the absence of identified organic pathology for rumination, medical interventions are of questionable efficacy and because of the risks and side effects associated with these procedures, are seldom the intervention of first choice for functional rumination. Behavioral procedures for the treatment of vomiting and rumination are described and critically reviewed for their efficacy, side effects, and the generalization and maintenance of their effects. Although methodological weaknesses limit conclusions regarding the efficacy of some behavioral interventions, several procedures have sound experimental support including oral hygiene, differential reinforcement of incompatible behaviors, and food satiation procedures. These behavioral interventions are the treatments of choice when organic causes of rumination cannot be identified. Suggestions for future research and applications are discussed.

Acceptability of Treatments for Trichotillomania Effects of Age and Severity

Based on the literature, trichotillomania (TTM, chronic hair pulling) in children and adults appears to be responsive to behavioral interventions such as habit reversal. However, some have questioned the generality and acceptability of such procedures. This study compared the acceptability ratings of four interventions targeting TTM (habit reversal, hypnosis, medication, and punishment). In the study, 233 college students read case vignettes in which the age of the analogue client and the severity of the hair pulling were manipulated. Results showed significant differences between the four treatment conditions, with hypnosis and habit reversal being rated most acceptable. Age of the analogue client and severity of TTM did not significantly influence acceptability ratings.

Social Validation of Applied Behavioral Research

Among the defining features of applied behavioral research is the emphasis on socially important behaviors and the insistence that treatment-produced changes in those behaviors be of practical value (Baer, Wolf, & Risley, 1968). These criteria have been broadly embraced by applied researchers and practitioners. Despite the concern for social importance and clinical significance in applied research, a methodology to evaluate how much of these valued characteristics a behavioral intervention possesses has been slow in developing.