Multicomponent Behavioral Intervention Research Articles

Effects of a multicomponent behavioral intervention on impulsivity and cognitive deficits in adolescents with excess weight

The aim of this study was to explore the effects of a multidisciplinary behavioral intervention including cognitive behavioral therapy, structured physical activity, and dietary counseling on impulsive personality and cognitive skills and subsequent BMI loss in excess weight adolescents. Forty-two adolescents with excess weight (14 males and 28 females, range 12-17 years), as defined by the International Obesity Task Force Criteria, participated in our study. We used a longitudinal observational design with two assessments: before and after treatment. We collected baseline measures of impulsive personality (UPPS-P scale), cognitive performance (letter number sequencing, Stroop and Iowa gambling task), and biometric parameters. After 12 weeks of intervention, parallel measures were used to determine whether treatment-induced changes in impulsivity and cognition predicted changes in BMI. BMI showed a statistically significant reduction after treatment [from mean (SD) 29.36 (4.51) to 27.31 (4.41), Cohen's d=0.5]. Greater reductions in negative urgency (negative-emotion-driven impulsivity) and greater improvement in cognitive inhibitory control skills were associated with greater reductions in BMI. Because the design was correlational and lacked a control group, future studies should clarify whether these associations reflect a causal effect or just overlapping improvements associated with a third variable (e.g. increases in attention procurement or motivation).

Pharmacological approaches to feeding behaviour and eating disorders

Pharmacological approaches to feeding behaviour and eating disorders

Dismantling multicomponent behavioral treatment for insomnia in older adults: a randomized controlled trial.

Recently, the use of multicomponent insomnia treatment has increased. This study compares the effect of single component and multicomponent behavioral treatments for insomnia in older adults after intervention and at 3 months and 1 yr posttreatment. A randomized, controlled study. Veterans Affairs medical center. 179 older adults (mean age, 68.9 yr ± 8.0; 115 women [64.2%]) with chronic primary insomnia. Participants were randomly assigned to 6 wk of stimulus control therapy (SCT), sleep restriction therapy (SRT), the 2 therapies combined into a multicomponent intervention (MCI), or a wait-list control group. Primary outcomes were subjective (daily sleep diary) and objective (actigraphy) measures of sleep-onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), time in bed (TIB), and sleep efficiency (SE). Secondary outcomes were clinical measures including response and remission rates. There were no differences between the single and multicomponent interventions on primary sleep outcomes measured by diary and actigraphy. All treatments produced significant improvement in diary-reported sleep in comparison with the control group. Effect sizes for sleep diary outcomes were medium to large. Treatment gains were maintained at follow-up for diary and actigraph measured SOL, WASO, and SE. The MCI group had the largest proportion of treatment remitters. For older adults with chronic primary insomnia, the findings provide initial evidence that SCT, SRT, and MCI are equally efficacious and produce sustainable treatment gains on diary, actigraphy, and clinical outcomes. From a clinical perspective, MCI may be a preferred treatment due to its higher remission rate. Behavioral Intervention for Insomnia in Older Adults. NCT01154023. URL: http://clinicaltrials.gov/ct2/show/NCT01154023?term=Behavioral+Intervention+for+Insomnia+in+Older+Adults&rank=1.

A Primary Care–Based, Multicomponent Lifestyle Intervention for Overweight Adolescent Females

Most clinic-based weight control treatments for youth have been designed for preadolescent children by using family-based care. However, as adolescents become more autonomous and less motivated by parental influence, this strategy may be less appropriate. This study evaluated a primary care-based, multicomponent lifestyle intervention specifically tailored for overweight adolescent females. Adolescent girls (N = 208) 12 to 17 years of age (mean ± SD: 14.1 ± 1.4 years), with a mean ± SD BMI percentile of 97.09 ± 2.27, were assigned randomly to the intervention or usual care control group. The gender and developmentally tailored intervention included a focus on adoptable healthy lifestyle behaviors and was reinforced by ongoing feedback from the teen's primary care physician. Of those randomized, 195 (94%) completed the 6-month posttreatment assessment, and 173 (83%) completed the 12-month follow-up. The primary outcome was reduction in BMI z score. The decrease in BMI z score over time was significantly greater for intervention participants compared with usual care participants (-0.15 in BMI z score among intervention participants compared with -0.08 among usual care participants; P = .012). The 2 groups did not differ in secondary metabolic or psychosocial outcomes. Compared with usual care, intervention participants reported less reduction in frequency of family meals and less fast-food intake. A 5-month, medium-intensity, primary care-based, multicomponent behavioral intervention was associated with significant and sustained decreases in BMI z scores among obese adolescent girls compared with those receiving usual care.

The efficacy of a peer-assisted multi-component behavioral intervention among female entertainment workers in China: an initial assessment

Women working in China's entertainment industry are at increased risk of acquiring or transmitting HIV/sexually transmitted infections (STIs). Efforts to develop effective risk-reduction interventions for female entertainment workers (FEWs) remain limited. We conducted a randomized controlled trial of a theory-based risk-reduction intervention among FEWs in Shanghai. The intervention condition consisted of small group, peer-assisted sessions integrating information-motivation-behavioral skills training with social influences of behavior change. The control condition was an attention-matched HIV, health education, and counseling. At three-month post-intervention, participants in the intervention condition reported greater reductions in unprotected sex with a stable partner than participants in the control condition. However, participants in the control condition reported greater reductions in unprotected sex with a non-stable partner than participants in the intervention condition. Some aspects of the study design may have diluted the effects of the intervention. Future intervention studies need to pay more attention to social influences of behavior change and the particular challenges of risk-reduction with stable partner(s).

Long-term effect on mortality of a multicomponent cognitive behavioural group intervention to reduce fear of falling in older adults: a randomised controlled trial

Long-term effect on mortality of a multicomponent cognitive behavioural group intervention to reduce fear of falling in older adults: a randomised controlled trial

Mediating effects of psychosocial factors on concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention

Objectives: Concerns about falling, or fear of falling, is highly common in old age and has adverse consequences. The development and understanding of interventions to reduce concerns about falling are therefore relevant. This study explored the mediating effects of psychosocial factors on trajectories of concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention. Method: The study sample comprised 540 community-dwelling adults aged 70 years or older, with concerns about falling and associated activity avoidance, who participated in a randomized controlled trial evaluating this intervention. Control beliefs, self-efficacy beliefs, outcome expectations, and social interactions, as potential mediators, and concerns about falling and daily activity, as outcome variables, were assessed at baseline, and at two, eight, and 14 months. Data were analyzed with mixed-effects regression models. Results: Small to moderate statistically significant effects of the intervention on the potential mediators were found at nearly all follow-up assessments. Separate psychosocial factors showed modest mediating effects on the outcomes. When all mediators were taken into account simultaneously, 44–76% of the association between the intervention and the outcomes was explained. Conclusion: This study showed that the multicomponent cognitive behavioral intervention improved control beliefs, self-efficacy, outcome expectations, and social interactions. These variables mediated the association between the intervention and concerns about falling or daily activity in community-dwelling older adults. This knowledge may facilitate further improvement and development of interventions to reduce concerns about falling and to increase daily activity.

Multicomponent behavioral treatment for chronic combat-related posttraumatic stress disorder: A randomized controlled trial

This study examined the efficacy of a multicomponent cognitive-behavioral therapy, Trauma Management Therapy, which combines exposure therapy and social emotional rehabilitation, to exposure therapy only in a group of male combat veterans with chronic posttraumatic stress disorder (PTSD). Thirty-five male Vietnam veterans with PTSD were randomly assigned to receive either Trauma Management Therapy (TMT) or Exposure Therapy Only (EXP). Participants were assessed at pre-treatment, mid-treatment, and post-treatment. Primary clinical outcomes were reduction of PTSD symptoms and improved social emotional functioning. Results indicated that veterans in both conditions showed statistically significant and clinically meaningful reductions in PTSD symptoms from pre- to post-treatment, though consistent with a priori hypotheses there were no group differences on PTSD variables. However, compared to the EXP group, participants in the TMT group showed increased frequency in social activities and greater time spent in social activities. These changes occurred from mid-treatment (after completion of exposure therapy) to post-treatment (after completion of the social emotional rehabilitation component); supporting the hypothesis that TMT alone would result in improved social functioning. Although the TMT group also had a significant decrease in episodes of physical rage, that change occurred prior to introduction of the social emotional component of TMT. This study demonstrates efficacy of exposure therapy for treating the core symptoms of PTSD among combat veterans with a severe and chronic form of this disorder. Moreover, multi-component CBT shows promise for improving social functioning beyond that provided by exposure therapy alone, particularly by increasing social engagement/interpersonal functioning in a cohort of veterans with severe and chronic PTSD.

Case Study: A Case-Series Evaluation of a Behavioral Sleep Intervention for Three Children with Autism and Primary Insomnia

To assess the effectiveness of a manualized multi-component behavioral sleep intervention for children with autism spectrum disorder (ASD) and primary insomnia. Three children (2 males and 1 female, aged 8-9 years) participated. The intervention consisted of a treatment handbook for parents; a distance treatment approach was used in which parents had weekly telephone contact with a therapist. The main behavioral strategies employed were Faded Bedtime with Response Cost and positive reinforcement. Within a case-series design, both subjective (parent-report questionnaires and sleep diaries) and objective (actigraphy) measures were used to record changes in children's sleep and daytime behavior. For all 3 children, mean sleep onset latency was reduced following the intervention. These improvements were generally maintained at follow-up 12 weeks later. The current study provides preliminary evidence for the effectiveness of a manualized behavioral sleep intervention program for improving insomnia in children with ASD.

The Contribution of Mindfulness Practice to a Multicomponent Behavioral Sleep Intervention Following Substance Abuse Treatment in Adolescents: A Treatment-Development Study

ABSTRACT Poor sleep is common in substance use disorders (SUDs) and is a risk factor for relapse. Within the context of a multicomponent, mindfulness-based sleep intervention that included mindfulness meditation (MM) for adolescent outpatients with SUDs (n = 55), this analysis assessed the contributions of MM practice intensity to gains in sleep quality and self-efficacy related to SUDs. Eighteen adolescents completed a 6-session study intervention and questionnaires on psychological distress, sleep quality, mindfulness practice, and substance use at baseline, 8, 20, and 60 weeks postentry. Program participation was associated with improvements in sleep and emotional distress, and reduced substance use. MM practice frequency correlated with increased sleep duration and improvement in self-efficacy about substance use. Increased sleep duration was associated with improvements in psychological distress, relapse resistance, and substance use–related problems. These findings suggest that sleep is an important therapeutic target in substance abusing adolescents and that MM may be a useful component to promote improved sleep.

A multicomponent behavioural and drug intervention for nocturia in elderly men: rationale and pilot results

OBJECTIVES To evaluate the number of medical and urological conditions associated with nocturia in a cohort of older men who were primary-care enrolees, and to assess the feasibility and efficacy of using a multicomponent intervention to reduce nocturia and its bother. SUBJECTS AND METHODS Men aged > or =50 years and with two or more episodes of nocturia were recruited from the primary-care clinics at one Veterans Affairs Medical Center to participate in a 4-week, open-label, prospective pilot study. A multicomponent intervention composed of behavioural therapy and targeted drug therapy was administered according to a specified protocol based upon identified risk factors for nocturia. Outcome measures included self-reported nocturia and bother on the American Urological Association (AUA)-7 Symptom Index, 3-day bladder diaries and self-reported sleep-related measures recorded using 7-day sleep diaries. RESULTS Fifty-five men completed the protocol (mean age 67 years, sd 8.3); they had a mean of 4.5 of nine defined conditions potentially related to nocturia. Highly prevalent conditions included moderate-to-severe benign prostatic hyperplasia (87%), hypertension (86%) and urinary frequency (71%). The mean diary-recorded nocturia decreased from 2.6 to 1.9 (P < 0.001), and bother score reduced from 3.1 to 1.1, representing a change from a 'medium' to a 'very small' problem (on a 5-point scale). Sleep diary-derived measures also improved significantly (time to initiate sleep, time to return to sleep after awakening, quality of sleep). CONCLUSIONS Given that individual older patients often have multiple coexistent risk factors for nocturia, identifying a principal cause of nocturia, a concept emphasized in treatment guidelines, proved to be difficult. Implementing a multicomponent behavioural intervention combined with drug(s) was feasible in older men and reduced nocturia frequency, bother from nocturia, and time to initiate sleep, within 4 weeks. These promising results merit repeating using a randomized, controlled trial.

Effect of Behavioral Intervention on Comorbid General Anxiety Disorder and Parkinson's Disease

A multiple-baseline, across-behaviors experimental design was used to evaluate the effects of a multicomponent behavioral intervention for anxiety secondary to Parkinson's disease (PD). A 67-year-old man with an 18-year history of PD, a 13-year history of anxiety, and meeting DSM-IV-TR criteria for general anxiety disorder (GAD) took part in the study. Dependent variables were the Clinical Anxiety Scale (CAS), Subjective Unit of Discomfort (SUD) ratings, and the Behavioral Relaxation Scale, a direct observation measure of relaxed behavior. Systematic increases in relaxed behavior with corresponding reductions in SUD ratings and CAS scores were obtained following Behavioral Relaxation Training (BRT). Further decreases in SUD ratings occurred following BRT + Imagery and BRT + Coping. Generalization assessment of relaxed behavior in the home environment indicated 78% relaxed. Social validity ratings, obtained by a “blinded” rater during neuropsychological assessment, indicated the patient was as “calm as other individuals.” Behavioral intervention was rated as highly acceptable. Behavioral intervention was beneficial in reducing anxiety beyond that obtained by medication alone. Further research replicating these findings is needed.

Research Evaluating Brief Behavioral Sleep Treatments for Rural Elderly (RESTORE): A Preliminary Examination of Effectiveness

To test the effectiveness of brief behavioral intervention for insomnia in rural elderly. Twenty older insomniacs (> or =65 years of age) were randomly assigned to sleep hygiene education (SHE; N = 9) or multicomponent behavioral treatment (MBT; N = 11). Rural care providers individually administered treatment (two in-person sessions/two telephone follow-ups). Training involved a two-day workshop. At posttreatment, 10 MBT participants no longer met criteria for insomnia compared to 3 SHE participants. Brief behavioral intervention for late-life insomnia can be quickly taught and effectively delivered by "real-world" care providers in rural primary care settings.

Project CARE: A Randomized Controlled Trial of a Behavioral Intervention Group for Alzheimer's Disease Caregivers

The neuropsychiatric symptoms associated with Alzheimer's disease are a major contributor to caregiver distress and burden. Despite recent efforts to teach caregivers skills to manage neuropsychiatric symptoms and reduce burden, there continues to be limited evidence that these strategies have helped caregivers of individuals with Alzheimer's disease to effectively manage neuropsychiatric symptoms. We report here on Project CARE, a randomized controlled trial designed to test the effectiveness of a caregiver-based multicomponent behavioral intervention aimed to reduce caregiver distress related to neuropsychiatric symptoms, as well as general caregiver burden, and to decrease neuropsychiatric symptom severity among individuals with Alzheimer's disease. The behavioral intervention involved five weekly sessions designed to teach caregivers specific techniques for managing patient neuropsychiatric symptoms in the home environment. Through the use of a randomized control trial, 80 caregivers were assigned to either the behavioral intervention group or a psychoeducational control group and were assessed both before and after the intervention. Compared with caregivers in the control group, caregivers in the behavioral intervention group displayed significantly greater reductions in caregiver distress related to neuropsychiatric symptoms (p=.005). Global caregiver burden, however, did not decrease significantly for caregivers in either group (p>.05). Although it was not statistically significant, there was a trend toward greater reductions in care recipients' neuropsychiatric symptom severity in the intervention group (p=.10). The current findings suggest that targeted, group-based behavioral interventions are effective for reducing distress related to neuropsychiatric symptoms among caregivers of individuals with Alzheimer's disease and for reducing care recipients' neuropsychiatric symptoms.

Treatment for ADHD: Is More Complex Treatment Cost‐Effective for More Complex Cases?

To determine the cost-effectiveness of three alternative high-quality treatments for attention deficit hyperactivity disorder (ADHD) relative to community care (CC) and to determine whether cost-effectiveness varies with the presence of comorbid disorders. DATA SOURCES/COLLECTION: The study included 579 children ages 7-9.9 with diagnosed ADHD at six sites. Data for the study were distilled from administrative data and from interviews with parents, including estimates of the child's functional impairment. These analyses focus on changes in functional impairment over 14 months. The study involved a large clinical trial that randomized participants to one of four arms: routine CC, intensive medication management (MedMgt), multicomponent behavioral treatment, and a combination of behavioral treatment and medication. We assessed the cost-effectiveness of the alternatives using costs measured from a payer perspective. The preferred cost-effective treatment varies as a function of the child's comorbidity and of the policy maker's willingness to pay. For pure (no comorbidity) ADHD, high-quality MedMgt appears likely to be cost-effective at all levels of willingness to pay. In contrast, for some comorbid conditions, willingness to pay is critical: the policy maker with low willingness to pay likely will judge MedMgt most cost-effective. On the other hand, a policy maker willing to pay more now in expectation of future costs savings (involving, for example, juvenile justice), will recognize that the most cost-effective choice for comorbid conditions likely involves behavior therapy, with or without medication. Analyses of costs and effectiveness of treatment for ADHD must consider the role of comorbidities.

Effects of Comprehensive Lifestyle Modification on Diet, Weight, Physical Fitness, and Blood Pressure Control: 18-Month Results of a Randomized Trial

The main 6-month results from the PREMIER trial showed that comprehensive behavioral intervention programs improve lifestyle behaviors and lower blood pressure. To compare the 18-month effects of 2 multicomponent behavioral interventions versus advice only on hypertension status, lifestyle changes, and blood pressure. Multicenter, 3-arm, randomized trial conducted from January 2000 through November 2002. 4 clinical centers and a coordinating center. 810 adult volunteers with prehypertension or stage 1 hypertension (systolic blood pressure, 120 to 159 mm Hg; diastolic blood pressure, 80 to 95 mm Hg). A multicomponent behavioral intervention that implemented long-established recommendations ("established"); a multicomponent behavioral intervention that implemented the established recommendations plus the Dietary Approaches to Stop Hypertension (DASH) diet ("established plus DASH"); and advice only. Lifestyle variables and blood pressure status. Follow-up for blood pressure measurement at 18 months was 94%. Compared with advice only, both behavioral interventions statistically significantly reduced weight, fat intake, and sodium intake. The established plus DASH intervention also statistically significantly increased fruit, vegetable, dairy, fiber, and mineral intakes. Relative to the advice only group, the odds ratios for hypertension at 18 months were 0.83 (95% CI, 0.67 to 1.04) for the established group and 0.77 (CI, 0.62 to 0.97) for the established plus DASH group. Although reductions in absolute blood pressure at 18 months were greater for participants in the established and the established plus DASH groups than for the advice only group, the differences were not statistically significant. The exclusion criteria and the volunteer nature of this cohort may limit generalizability. Although blood pressure is a well-accepted risk factor for cardiovascular disease, the authors were not able to assess intervention effects on clinical cardiovascular events in this limited time and with this sample size. Over 18 months, persons with prehypertension and stage 1 hypertension can sustain multiple lifestyle modifications that improve control of blood pressure and could reduce the risk for chronic disease.

Regulated breathing as a treatment for stuttering: A review of the empirical evidence.

Abstract Regulated Breathing (RB) is a behavioral treatment for stuttering designed to address airflow irregularities by teaching breathing patterns that are incompatible with stuttering. The current paper describes the RB procedure and reviews published literature to examine the empirical support for the efficacy of RB. Existing data indicate that RB is an effective treatment for stuttering and could be considered a probably efficacious treatment according to the criteria described by Chambless and Ollendick (2001). Limitations of the present literature are discussed, as well as suggestions and possible directions for future research. Keywords: Regulated Breathing, Stuttering. Introduction Stuttering is characterized by a disturbance in the normal fluency and time patterning of speech (APA, 2000). Speech disturbances include frequent occurrences of sound, syllable, and whole-word repetitions; sound prolongations or hesitations; interjections; broken words; or circumlocutions. The Diagnostic and Statistical Manual of Mental Disorders includes the criterion that stuttering interferes with academic, occupational or social functioning and must not be better accounted for by a speech-motor or sensory deficit (APA, 2000). However, a diagnosis of stuttering in young children is often given even in the absence of functional impairment. When young children are diagnosed, speech patterns are usually evaluated and compared to the normal fluency for their age group (APA, 2000). Clinicians also take into consideration developmental and emotional factors that can disrupt a child's speech (Williams, 1985). Prevalence rates of stuttering are approximately 1% (Bloodstein, 1995) but can be as high as 5% during childhood (Leung & Robson, 1990). The onset of stuttering usually occurs between the ages of 2 and 6 (Andrews et al., 1983; Homzie & Lindsay, 1984) and is more common in males. The male-to-female gender ratio is 3 to 1 during childhood and increases to 5 to 1 in adulthood (APA, 2000, Bloodstein, 1995). Although a specific cause for stuttering is not known, it is believed to be a heritable disorder (Felsenfeld et al., 2000; Andrews, Morris-Yates, Howie, & Martin, 1991). Stuttering is associated with various airflow irregularities. Healey (1991) suggested that stuttering is primarily associated with the tightening of the laryngeal muscles in the throat, resulting in a disruption of airflow and speech production, and Bloodstein (1995) noted that in some cases a complete cessation of breathing or an irregularity of the respiratory cycle occurs during stuttering. Also, people who stutter tend to have less airflow during speech difficulties involving the coordination of laryngeal muscles, which results in decreased air volume in the lungs before speech initiation (Stager, Denman, and Ludlow, 1997). To address the issue of airflow irregularities in stuttering, modification of speech-related respiratory behavior is believed to be useful in the treatment of the disorder. Description of Regulated Breathing Regulated Breathing (RB) is a multicomponent behavioral treatment that attempts to inhibit stuttering by teaching a speech-related breathing pattern that is incompatible with stuttering (Azrin & Nunn, 1973). RB consists of several different treatment components, including awareness training, relaxation, competing response training, motivation training, and generalization training. It shows significant overlap with habit reversal, a procedure designed to treat nervous habits and motor tics. Awareness Training. Awareness training is comprised of four techniques. During response description, the client deliberately stutters and provides a detailed verbal description of physical movements, sounds, and sensations (tension) associated with his or her stuttering. The second awareness technique, response detection, requires a client to point out a stutter when it occurs. …

Habit Reversal Training for Tic Disorders in Children and Adolescents

Chronic tic disorders, including Tourette's syndrome (TS), affect approximately .5% of children and adolescents. Although strong evidence exists supporting a neurobiological etiology, operant factors may play a role in the maintenance of tic behaviors. Pharmacological approaches remain the most commonly used intervention for chronic tic disorder in children and adults. Nevertheless, the unpredictable efficacy and serious side effects associated with medication along with parental concerns about long-term medication use in children underlie the need for nonpharmacological interventions for tics in this age group. This article reviews the rationale and evidence base for the use of habit reversal training (HRT), a multicomponent behavioral treatment package, as a treatment for childhood tics. Each of the primary treatment components of HRT is described and implementation is illustrated in case report format. A growing body of data suggests that HRT is a well-tolerated and efficacious intervention for tic disorders in this age group.

Best practice in group-based smoking cessation: results of a literature review applying effectiveness, plausibility, and practicality criteria.

Apply a "best practices" model to evidence regarding group smoking cessation to inform organizational decisions about adopting such programs. The best-practices model attempts to integrate rigorous review of evidence with context and practical considerations important to organizations contemplating adoption. First, we identified effective practices by systematic literature review with two blinded reviewers to (1) search databases (99.8% agreement), (2) hand search journals with five or more papers selected in first step (99.9% agreement), (3) search reference lists of included papers (99.4% agreement), and (4) contact published experts. Second, model programs, theory, and expert opinion suggested plausible practices. Finally, a practitioner-researcher advisory group suggested practical considerations affecting adoption decisions. All 67 studies included in the review met six requirements: (1) peer reviewed, (2) primary studies, (3) using experimental or quasi-experimental design, (4) compared one or more smoking-cessation interventions that involved two or more group sessions, (5) studied persons 18+ years old, and (6) reported > or =6-month point prevalence or continuous abstinence outcomes. Two independent raters assessed study quality (89.5% agreement). Effective practices consistently exhibited a statistically significant effect. Plausible practices showed consistency across three types of evidence. An advisory group based practicality criteria on critical review and experience. Two practices were rated effective: multicomponent behavioral intervention and nicotine replacement therapy. Five practices received plausible ratings: components of behavioral skills, information about smoking, self-monitoring, social support, and four or more sessions of 60 to 90 minutes. The Advisory Group identified 11 practicality questions to assist organizations to make adoption decisions regarding effective and plausible practices. No research evidence guides potential smoking-cessation program adopters regarding program participants, providers, settings, or quality assurance. Reviews to influence practice must consider science and practice (context) to facilitate adoption of best practices.

BEHAVIORAL TREATMENT FOR CHILD DISTRESS DURING REPEATED NEEDLE STICKS

The objective of this study was to evaluate a multi-component behavioral intervention for child distress during repeated needle sticks. An AB single-subject experimental design with replication of procedures across five subjects was used to assess intervention effects on distress and procedure duration for five children (age 3–7 years). Playing preferred activities, signaled button pressing, and following directions were positively reinforced first during simulated then actual needle procedures. The results indicate that distress decreased substantially for three children, slightly for a fourth and was unchanged for one. Heart rate (HR) data obtained from one child provided preliminary evidence of counterconditioning. For three children with follow-up data, benefits were maintained after intervention transfer to caregivers. In conclusion, distraction and counter-conditioning appear to be compatible conceptualizations for designing interventions to reduce the distress of experienced children who undergo repeated invasive procedures. The independent and synergistic effects of behavioral interventions based on these two theories should be examined in future studies.