Contingency Management Techniques Research Articles

Effectiveness of Habit Reversal and Contingency Management Techniques on Study Habit Behaviour of Secondary School Students

The paper investigates the impact of Habit Reversal Technique (HRT) and Contingency Management (CMT) on the study habits of secondary school students, employing a quantitative research approach and secondary data sources. The results indicated that HRT effectively improves students' study habits, while CMT also demonstrates a positive influence on study habits. The study concludes that HRT can effectively transform negative behaviors, including poor study habits, into positive ones. Additionally, CMT is found to enhance both academic and non-academic activities, including study habits. The recommendations include granting school counselors the authority to utilize HRT for treating students with inadequate study habits and implementing CMT, involving reinforcement like tokens, to motivate students to adopt positive study habits.

Components of Behavioral Parent Training for Children With Attention-Deficit/Hyperactivity Disorder: A Series of Replicated Single-Case Experiments.

Behavioral parent training (BPT) is an evidence-based treatment for children with attention-deficit/hyperactivity disorder (ADHD). Stimulus control techniques (antecedent-based techniques, e.g., clear rules, instructions) and contingency management techniques (consequent-based techniques, e.g., praise, ignore) are the most common ones that are being taught to parents in BPT. However, research into the additive effects of these techniques is scarce. In this replicated single-case experimental ABC phase design, including six children on stable medication for ADHD (8-11 years) and their parents, the added efficacy of consequent-based techniques on top of antecedent-based techniques was evaluated. After a baseline period (phase A), we randomized the commencement time of two sessions parent training in antecedent-based techniques and two sessions parent training in consequent-based techniques for each child. Children's behaviors were assessed by daily parent ratings of selected problem behaviors and an overall behavior rating. Although visual inspection showed that behavior improved for most children in both phases, randomization tests did not demonstrate the added efficacy of the consequent-based techniques on top of the antecedent-based techniques. Limitations of the study and recommendations for future single-case experiments in this population are discussed.

Attachment Representation Moderates the Effectiveness of Behavioral Parent Training Techniques for Children with ADHD: Evidence from a Randomized Controlled Microtrial

Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but knowledge on the differential effects of behavioral techniques for specific subgroups of children is very limited. Attachment representations of children with ADHD may affect how receptive children are to changes in parenting. In this study, we investigated whether specific behavioral techniques were more or less effective for children with ADHD in relation to their attachment representations. We included parents of 74 children with ADHD (4–11 years, M = 8.15) who took part in a larger randomized controlled microtrial in which they were randomized to a two session training in antecedent-based techniques (i.e., stimulus control techniques: rules, instructions; n = 26), a two session training in consequent-based techniques (i.e., contingency management techniques: praise, rewards, ignoring; n = 25) or a waitlist control condition (n = 23). We examined whether attachment representation moderated the effectiveness of a) training versus waitlist, and b) antecedent- versus consequent-based techniques. Attachment representations were measured with a story stem task, the intervention outcome was daily parent-rated problem behaviors of the children. Attachment representation did not moderate the effects of the training compared to the waitlist. However, compared to antecedent-based techniques, consequent-based techniques were less effective for more securely and less disorganized attached children, and particularly effective for more disorganized attached children. This was the first study examining attachment as a moderator of behavioral techniques for ADHD. If replicated, the findings of this study can be used for treatment development and tailoring.

Effectiveness of Specific Techniques in Behavioral Teacher Training for Childhood ADHD Behaviors: Secondary Analyses of a Randomized Controlled Microtrial

Behavioral teacher training is an effective intervention for children with attention-deficit/hyperactivity disorder (ADHD). Intervention effectiveness may be enhanced by including intervention components that carry the strongest evidence for their effectiveness. A previous article of this group showed that both antecedent- (i.e., stimulus-control) and consequent-based (i.e., contingency management) techniques were highly effective in reducing daily teacher-rated, individually selected problem behaviors in a specific situation of the child. Effects were observed up to three months post intervention. Here, we tested whether effects were also present in teacher-rated and masked DSM-based assessments that comprise the full range of ADHD and oppositional defiant disorder (ODD) symptoms, as well as on teacher-rated impairment. Teachers of 90 children with (subthreshold) ADHD (6–12 years) were randomly assigned to one of three conditions: a short (two sessions), individualized intervention consisting of either a) antecedent-based techniques or b) consequent-based techniques; or c) waitlist. Multilevel analyses showed that both sets of techniques were effective in reducing teacher-rated ADHD symptoms and impairment immediately after the intervention and up to three months later, as compared to waitlist. Masked observations of ADHD behavior were in line with teacher ratings, with effects being most pronounced for inattention. No effects on teacher-rated or masked ODD behavior were found. This study showed that antecedent- and consequent-based techniques were effective in improving classroom ADHD symptoms and impairment. Long-term changes in teacher-rated ADHD are promising. These results extend previous findings and show the potential of short individually tailored interventions in classroom settings as treatment of ADHD symptoms.

Child neurocognitive functioning influences the effectiveness of specific techniques in behavioral teacher training for ADHD: Moderator analyses from a randomized controlled microtrial.

Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with several neurocognitive impairments. Whether these impairments influence the effectiveness of techniques that are commonly used in behavioral teacher training for ADHD has not been investigated so far. In this microtrial, teachers of 90 children with ADHD symptoms (6-12years) were randomly assigned to a short intervention consisting of either antecedent-based (stimulus-control) techniques or consequent-based (contingency management) techniques, or to a waitlist control condition. Primary outcome was the daily assessment of individually selected problem behavior, assessed pre- and post-intervention. Potential neurocognitive moderators of treatment effect included teacher ratings of cognitive control, reward, and punishment sensitivity, and measures derived from computerized neurocognitive tasks, including attentional lapses, interference control, visuospatial working memory, and emotional functioning. Intervention condition by moderator interactions were assessed in separate multilevel mixed models. Lapses of attention, working memory, and emotional functioning interacted with intervention effectiveness. Antecedent-based techniques were effective independent of these neurocognitive functions; consequent-based techniques were (more) effective when these functions were more impaired. The effectiveness of techniques was neither related to interference control nor to teacher-rated neurocognitive functioning. This study showed that child neurocognitive functioning influences the effectiveness of behavioral teacher techniques for children with ADHD symptoms. Findings suggest that antecedent-based techniques may be effective for all children, while consequent-based techniques have added value particularly for children who suffer from low visuospatial working memory, low emotional functioning, and/or large numbers of attentional lapses.

Which Techniques Work in Behavioral Parent Training for Children with ADHD? A Randomized Controlled Microtrial

ABSTRACT Objective Behavioral parent training (BPT) is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the effects of separate techniques parents learn in BPT. Method In a three-armed randomized controlled microtrial including parents of 92 children (4–12 years) with ADHD, we examined the efficacy of two sessions parent training involving either stimulus control techniques (antecedent-based condition (AC)) or contingency management techniques (consequent-based condition (CC)), compared to a waitlist. Primary outcome was daily parent-rated problem behaviors, secondary outcomes were parent-rated symptoms of ADHD and oppositional defiant disorder (ODD), and mental health-care consumption. Measures were completed at baseline (T0), immediately after the training (T1), at two weeks (T2) and three months (T3) follow-up. We also explored whether child and parent characteristics moderated treatment effects. Results Compared to the waitlist, in the AC, daily rated problem behaviors improved at T1 (d= .56) and T2 (d= .65); in the CC, these behaviors only improved at T2 (d= .53). Daily rated problem behaviors within both conditions remained stable between T2 and T3. In the AC compared to the other conditions, inattention symptoms decreased at T1 and T2. For both active conditions compared to waitlist, hyperactivity-impulsivity symptoms decreased only at T2 and ODD symptoms did not decrease. No moderators were identified. Mental health-care consumption after training was low and did not differ between the active conditions. Conclusions Brief training of parents in antecedent- or consequent-based techniques improves problem behaviors of children with ADHD. Antecedent-based techniques appear to be especially important to target inattention.

Contingency management and cognitive behavioral therapy for trauma-exposed smokers with and without posttraumatic stress disorder

IntroductionTrauma-exposed individuals with and without posttraumatic stress disorder (PTSD) are more likely to smoke and less successful in quit attempts than individuals without psychopathology. Contingency management (CM) techniques (i.e., incentives for abstinence) have demonstrable efficacy for smoking cessation in some populations with psychopathology, but have not been well tested in PTSD. This pilot study examined the feasibility of CM plus brief cognitive behavioral therapy (CBT) in promoting smoking cessation among trauma-exposed individuals with and without PTSD. MethodsFifty trauma-exposed smokers (18 with PTSD) were asked to abstain from tobacco and nicotine replacement therapy for one month. During week one of cessation, CBT was provided daily and increasing CM stipends were paid for each continuous day of biochemically-verified abstinence; CM stipends were withheld in response to smoking lapses and reset to the initial payment level upon abstinence resumption. CBT and fixed payments for study visits were provided during the subsequent three weeks. ResultsOf the 50 eligible participants who attended at least one pre-quit visit (49% female, 35% current PTSD), 43 (86%) attended the first post-quit study visit, 32 (64%) completed the first week of CM/CBT treatment, and 26 (52%) completed the study. Post-quit seven-day point prevalence abstinence rates for participants with and without PTSD, respectively, were similar: 39% vs. 38% (1 week), 33% vs. 28% (2 weeks), 22% vs. 19% (3 weeks), and 22% vs. 13% (4 weeks). ConclusionsUse of CM + CBT to support tobacco abstinence is a promising intervention for trauma-exposed smokers with and without PTSD.

School-Based Behaviour Modification for Students with Attention Deficit Disorders: Placebo or Panacea?

The efficacy of School-based Behavior Modification (BM) treatments for students with Attention Deficit Disorders (ADD) is being debated. This article explored several empirical studies carried out (in the last decade) on effectiveness of the various BM interventions with a view to determining whether such approaches are mere placebo or panacea. Also issues regarding the various developmental difficulties encountered by students with ADD over time and across content areas are discussed. Furthermore, results from studies designed to determine the efficacy of some behavioral techniques such as; Contingency Management Techniques, Good Behavior Game, Self-mediation, Self-evaluation etc. are equally reviewed. Based on this review and evidence advanced in this text, the paper posits that School-based Behavioral Modification (BM) treatments for ADD are effective in the short run and indeed a panacea for reducing disruptive behaviors and improving on-task behavior and academic performance of students with the disorder. Keywords: Attention Deficit Disorders; Behavioral Modification; Placebo or Panacea

Contingency Management to Increase Grade Point Average Among Fraternity Members: A Feasibility Study

Contingency management is an incentive-based intervention strategy that has been demonstrated to be effective for inducing behavior change among a variety of populations and for a variety of behaviors. The current study examined whether contingency management techniques can help students change behaviors in an effort to raise their grade point averages. Members of a social fraternity participated in the study. We randomly assigned students to either a contingency management condition or a control condition. Throughout the entire semester, the contingency management students earned pulls from the fishbowl for reaching a grade criterion. For the first half of the semester, the control students were yoked to the contingency management group such that they earned pulls based on the other condition’s performance. For the second half of the semester, the control students began to experience the regular contingency management regimen. As hypothesized, the contingency management students’ GPA did increase during the semester and gains were maintained over time. Students in the control group did not show the same increase in grades. Contingency management appears to be effective in helping students raise their grades.

Marijuana and Adolescents: Treatment Strategies for Clinicians

Although marijuana dependency is probably the least severe of the drug dependencies in terms of acuity and severity of negative consequences, it is one of the most difficult to treat. In this paper I propose that some of the difficulty in treating marijuana dependency in adolescence is due to the adolescents impairment in recognizing the negative effects of regular use. This impairment in recognizing impairment is the result of the combination of both the executive function cognitive deficits and that everything is experienced in a mild high state. Adolescents then begin to lose the capacity to make meaningful logical connections between their drug usage and its effects on their life. Understanding this process helps the therapist to tolerate the frustrations in treating these adolescents. Suggested treatment interventions are to first establish an initial period of abstinence for 3-4 weeks. This can be done by utilizing one or more of the following: parental limit setting with random urine drug screens, contingency management techniques, direct suggestions to try abstinence for a limited time, and/or positive program peer pressure that abstinence is necessary to be part of the group. After a period of abstinence, the usual therapy approaches of motivational enhancement therapy, cognitive behavioral therapy, family therapy, community reinforcement approach, 12-Step mutual help programs and pharmacotherapy of co-morbid disorders may become more meaningful. Other practical clinical interventions with case examples are described. Keywords: Adolescents, marijuana, treatment, marijuana dependence disorder, Annual Meeting of the American Society for Adolescent Psychiatry, impairment, contingency management techniques, community reinforcement, CANNABIS, ADDICTION

A Testbed for Real-Time Autonomous Vehicle PHM and Contingency Management Applications

Autonomous unmanned vehicles are playing an increasingly important role in support of a wide variety of present and future critical missions. Due to the absence of timely pilot interaction and potential catastrophic consequence of unattended faults and failures, a real-time, onboard health and contingency management system is desired. This system would be capable of detecting and isolating faults, predicting fault progression and automatically reconfiguring the system to accommodate faults. This paper presents a robotic testbed that was developed for the purpose of developing and evaluating real-time PHM and Automated Contingency Management (ACM) techniques on autonomous vehicles. The testbed hardware is based on a Pioneer 3-AT robotic platform from Mobile Robots, Inc. and has been modified and enhanced to facilitate the simulations of select fault modes and mission-level applications. A hierarchical PHM-enabled ACM system is being developed and evaluated on the testbed to demonstrate the feasibility and benefit of using PHM information in vehicle control and mission reconfiguration. Several key software modules including a HyDE-based diagnosis reasoner, particle filtering-based prognosis server and a prognostics-enhanced mission planner are presented in this paper with illustrative experimental results. This testbed has been developed in hope of accelerating related technology development and raising the Technology readiness level(TRL)ofemergingACM techniques for autonomous vehicles.

Therapeutic enhancement: nursing intervention category for patients diagnosed with Readiness for Therapeutic Regimen Management

To present a new nursing intervention category called therapeutic enhancement. Fewer than half of North Americans follow their physician's recommendations for diet and exercise, even when such are crucial to their health or recovery. It is imperative that nurses consider new ways to promote healthy behaviours. Therapeutic enhancement is intended to provide such a fresh approach. Traditional intervention techniques focusing on education, contracts, social support and more frequent interaction with physicians appear not to be effective when used alone. Successful strategies have been multidisciplinary; and have included interventions by professional nurses who assist patients to understand their disease and the disease process and that helps them to develop disease-management and self-management skills. Therapeutic enhancement incorporates The Stages of Change Theory, Commitment to Health Theory, Motivational Interviewing techniques and instrumentation specifically designed for process evaluation of health-promoting interventions. This is a critical review of approaches that, heretofore, have not been synthesised in a single published article. Based on the commonly used Stages of Change model, therapeutic enhancement is useful for patients who are at the action stage of change. Using therapeutic enhancement as well as therapeutic strategies identified in Stages of Change Theory, such as contingency management, helping relationships, counterconditioning, stimulus control and Motivational Interviewing techniques, nursing professionals can significantly increase the chances of patients moving from action to the maintenance stage of change for a specific health behaviour. Using the nursing intervention category, therapeutic enhancement can increase caregivers' success in helping patients maintain healthy behaviours.

Contingency management for treatment of substance use disorders: a meta‐analysis

To examine the effectiveness of contingency management (CM) techniques in treating substance use disorders (i.e. illicit drugs, alcohol, tobacco). Meta-analysis was used to determine the average effect size and potential moderators in 47 comparisons of the effectiveness of CM from studies based on a treatment-control group design and published between 1970 and 2002. The mean effect size (ES) of CM was positive, with a magnitude of d = 0.42 using a fixed effects model. The magnitude of the ES declined over time, following treatment. CM was more effective in treating opiate use (d = 0.65) and cocaine use (d = 0.66), compared with tobacco (d = 0.31) or multiple drugs (d = 0.42). Larger effect sizes were associated with higher researcher involvement, earlier studies and shorter treatment duration. Study findings suggest that CM is among the more effective approaches to promoting abstinence during the treatment of substance use disorders. CM improves the ability of clients to remain abstinent, thereby allowing them to take fuller advantage of other clinical treatment components.

THE IMPACT OF ENHANCED INCENTIVES ON VOCATIONAL REHABILITATION OUTCOMES FOR DUALLY DIAGNOSED VETERANS

This study evaluated the efficacy of adding contingency management techniques to vocational rehabilitation (VR) to improve treatment outcome as measured by entry into competitive employment. Nineteen dually diagnosed veterans who entered VR in the Veterans' Administration's compensated work therapy (CWT) program were randomly assigned to CWT (n = 8) or to CWT with enhanced incentives (n = 11). Over the first 16 weeks of rehabilitation, those in the incentives condition could earn up to dollar 1,006 in cash for meeting two sets of clinical goals: (a) remaining abstinent from drugs and alcohol and (b) taking steps to obtain and maintain a competitive job. Results indicate that relative to participants in the CWT-only group, those in the incentives condition engaged in more job-search activities, were more likely to remain abstinent from drugs and alcohol, were more likely to obtain competitive employment, and earned an average of 68% more in wages. These results suggest that rehabilitation outcomes may be enhanced by restructuring traditional work-for-pay contingencies to include direct financial rewards for meeting clinical goals.

Contingency management treatments that reinforce completion of goal-related activities: Participation in family activities and its association with outcomes

Contingency management (CM) techniques that reinforce completion of nondrug related activities may be efficacious in treating substance dependence. No studies to date have evaluated whether involvement in particular types of activities reduces problems in those domains. One hundred fifty-nine cocaine-abusing adults who had been randomized to a CM intervention were categorized based on whether or not they engaged in three or more family related activities during the 12-week treatment period. Differences between the groups were evaluated with respect to treatment retention, length of continuous abstinence, and changes from baseline to the end of the intervention in ASI-family scores and days of family conflict. Participants who engaged in family activities ( N = 29) remained in treatment longer, were abstinent for more weeks, and reported greater reduction in family conflict compared to participants who did not engage in family activities ( N = 130). These data suggest that participants who elect to complete family related activities during CM treatments may evidence improved outcomes and reduced family conflict.

Improving On‐Time Counseling Attendance in a Methadone Treatment Program: A Contingency Management Approach

Two studies were conducted to investigate the effectiveness of contingency management techniques in promoting punctual counseling attendance among methadone maintenance patients. In Study 1, 50 participants were recruited from an inner‐city methadone maintenance program. Study 1 used an A–B–A design with baseline, intervention, and return‐to‐baseline phases. On‐time attendance was reinforced during the intervention phase with a voucher that was redeemable for a draw out of a box containing 100 tokens with values varying from $0.00 to $100.00. Methadone maintenance patients who exhibited poor attendance during baseline showed a significant positive response during the contingency management intervention phase. Study 2 used the same design as Study 1 except that the 52 participants were randomized into reinforcement groups that received either the variable rate of reinforcement as in Study 1 or a fixed value reinforcer of $3.25. As in Study 1, Poor Attenders significantly improved counseling attendance during the intervention. There were no differences between the variable and fixed reinforcement groups. Overall, results suggest that targeting Poor Attenders with contingency management techniques may be a cost‐effective method of improving counseling attendance. Targeting Poor Attenders early in treatment may be especially important for improving treatment outcomes.

Recent advances in the dissemination of contingency management techniques: clinical and research perspectives

Research studies have demonstrated the efficacy of contingency management procedures in treating substance use disorders. However, these procedures have only recently been adapted to and tested within community-based clinical settings. This article reviews recent advances in the field of contingency management, with attention to dissemination issues. Counselor's reactions to the implementation of these techniques in individual and group treatment modalities are detailed. Suggestions are made for areas in which more research is needed, from both a counselor's and researcher's perspective.

Challenges in the transfer of contingency management techniques: comment on Silverman et al. (2001).

This article critiques K. Silverman, D. Svikis, E. Robles, M. L. Stitzer, and G. E. Bigelow's (2001) study of a contingency management intervention for reinforcing development of job-related skills in substance abusing women. The strengths of Silverman et al.'s study include studying a patient population of major public health concern, expanding contingency management techniques to a vocational training setting, reinforcing gradual approximations, implementing the intervention for a long duration, and carefully designing and executing the experimental procedures. However, many of these strengths may also be interpreted as weaknesses if the ultimate goal is to apply contingency management techniques in self-sustaining, community-based settings. The need to evaluate long-term cost-effectiveness of these procedures is described, and the difficulties in transferring contingency management techniques to real-world settings is discussed.

Drug Courts and Contingency Management

Drug courts have become an increasingly popular response to the increased burden placed on the criminal justice system by substance abuse. However, evaluation findings have been less than consistent with respect to the ability of drug courts to have the desired impact on drug use and criminal behavior. This paper reviews the literature describing the growth, operations, and evaluations of drug courts. It concludes that, contrary to most “models,” drug courts emphasize punishment (e.g., graduated sanctions) and make limited positive, or at least inconsistent, use of reinforcement to promote behavior change and abstinence from drug use. Contingency management techniques that involve the systematic application of reinforcement based on the performance of specified behaviors are presented and reviewed. The success of this model in promoting pro-social behavior and abstinence from illicit drug use suggests that drug courts could benefit substantially from the integration of contingency management-based interventions.

Challenges in the transfer of contingency management techniques: Comment on Silverman et al. (2001).

Challenges in the transfer of contingency management techniques: Comment on Silverman et al. (2001).