Single-case Experimental Design Methodology Research Articles

How did the Treatment Work for Robin? And for Dylan? Studying Individual Youth Treatment Mediators Using Single-Case Experimental Designs

Study of individual treatment mechanisms in youth interventions facilitates evidence-based development, selection and implementation of treatment components that are most effective for each individual child. This position paper aims to bring together two important topics from the area of youth intervention research: mediators of treatment outcomes and single-case experimental design methodology. We start by outlining the benefits of studying within-person mechanisms and propose how statistical mediation analysis and single-case methods can be integrated to enable this type of research. Further, we review existing methodology for the study of individual youth treatment mechanisms and provide recommendations for the clinical practice research.

Single-Case Experimental Design for Evaluating Basic Reading Interventions for Students With Learning Disabilities: An Illustrative Case

Many students with learning disabilities (LD) do not master basic reading skills, which affects later reading fluency and reading comprehension development. Single-case experimental design (SCED) research yields unique opportunities to better understand which aspects of a basic reading intervention are effective with a particular student, including the individual’s rate of growth, stability, or maintenance of acquired skills, and whether or not modifications need to be made to the intervention under study. In this article, we use a case study illustration to highlight unique considerations for using SCED research to investigate basic reading interventions for students with LD. Finally, we provide a discussion of future directions and a potential shift in SCED methodology that is responsive to the comprehensive and multiple skill nature of reading instruction.

Effectiveness of cognitive analytic therapy for bipolar affective disorder: A co-produced single subject cumulative treatment design with extended follow-up (A1 /B/A2 /C-FU).

ObjectivesEvidence for the treatment of bipolar affective disorder with cognitive analytic therapy (CAT) is limited, and so this study sought to intensively evaluate outcomes in a co‐produced single‐case experimental design (SCED).DesignAn A1/B/A2/C with extended follow‐up SCED with a female patient meeting diagnostic criteria for bipolar disorder.MethodsFollowing the 6‐week baseline period ‘A1’, treatment occurred in two phases (18 ‘B’ and 6 sessions ‘C’) sandwiching a 12‐week treatment withdrawal phase (‘A2’) and a 24‐week structured follow‐up phase. Five idiographic daily measures were collected daily to create a 622‐day timeline. The PHQ‐9 and the Mania Rating Scale were completed after each treatment session. The participant held two roles: as the patient and provider of the idiographic/nomothetic outcomes and also as part of the research team through providing a commentary on the outcomes identified.ResultsCAT was a partially effective intervention. There were improvements to idiographic measures of self‐criticism, self‐acceptance, body dissatisfaction and worry. Nomothetic outcomes showed little change. CAT did not insulate from the occurrence of a hypermanic relapse during the follow‐up phase. The change commentary mirrored the idiographic outcomes in noting that the ‘exits’ were harder to implement during the manic relapse.ConclusionsThis co‐produced SCED suggests a partially effective CAT intervention, but with exits much harder to sustain during manic relapse. Methodologically, it is possible to improve SCED methodology through widening the participant role further beyond that of data collection.

A Mindfulness-Based Brain-Computer Interface to Augment Mandala Coloring for Depression: Protocol for a Single-Case Experimental Design.

BackgroundThe regular practice of mindfulness has been shown to provide benefits for mental well-being and prevent depression relapse. Technology-mediated interventions can facilitate the uptake and sustained practice of mindfulness, yet the evaluation of interactive systems, such as brain-computer interfaces, has been little explored.ObjectiveThe objective of this paper is to present an interactive mindfulness-based technology to improve mental well-being in people who have experienced depression. The system, Anima, is a brain-computer interface that augments mandala coloring by providing a generative color palette based on the unfolding mindfulness states during the practice. In addition, this paper outlines a multiple-baseline, single-case experimental design methodology to evaluate training effectiveness.MethodsAdult participants who have experienced depression in the past, have finished treatment within the last year, and can provide informed consent will be able to be recruited. The Anima system, consisting of 2 tablets and a nonintrusive mental activity headband, will be delivered to participants to use during the study. Measures include state and trait mindfulness, depression symptoms, mental well-being, and user experience, and these measures will be taken throughout the baseline, intervention, and monitoring phases. The data collection will take place in the form of a questionnaire before and after each mandala-coloring session and a semistructured interview every 2 weeks. Trial results will be analyzed using structured visual analysis, supplemented with statistical analysis appropriate to single-case methodology.ResultsStudy results will offer new insights into the deployment and evaluation of novel interactive brain-computer interfaces for mindfulness training in the context of mental health. Moreover, findings will validate the effectiveness of this training protocol to improve the mental well-being of people who have had depression. Participants will be recruited locally through the National Health Service.ConclusionsEvidence will assist in the design and evaluation of brain-computer interfaces and mindfulness technologies for mental well-being and the necessary services to support people who have experienced depression.International Registered Report Identifier (IRRID)PRR1-10.2196/20819

Evaluation of the Effectiveness of a Novel Brain-Computer Interface Neuromodulative Intervention to Relieve Neuropathic Pain Following Spinal Cord Injury: Protocol for a Single-Case Experimental Design With Multiple Baselines.

BackgroundNeuropathic pain is a debilitating secondary condition for many individuals with spinal cord injury. Spinal cord injury neuropathic pain often is poorly responsive to existing pharmacological and nonpharmacological treatments. A growing body of evidence supports the potential for brain-computer interface systems to reduce spinal cord injury neuropathic pain via electroencephalographic neurofeedback. However, further studies are needed to provide more definitive evidence regarding the effectiveness of this intervention.ObjectiveThe primary objective of this study is to evaluate the effectiveness of a multiday course of a brain-computer interface neuromodulative intervention in a gaming environment to provide pain relief for individuals with neuropathic pain following spinal cord injury.MethodsWe have developed a novel brain-computer interface-based neuromodulative intervention for spinal cord injury neuropathic pain. Our brain-computer interface neuromodulative treatment includes an interactive gaming interface, and a neuromodulation protocol targeted to suppress theta (4-8 Hz) and high beta (20-30 Hz) frequency powers, and enhance alpha (9-12 Hz) power. We will use a single-case experimental design with multiple baselines to examine the effectiveness of our self-developed brain-computer interface neuromodulative intervention for the treatment of spinal cord injury neuropathic pain. We will recruit 3 participants with spinal cord injury neuropathic pain. Each participant will be randomly allocated to a different baseline phase (ie, 7, 10, or 14 days), which will then be followed by 20 sessions of a 30-minute brain-computer interface neuromodulative intervention over a 4-week period. The visual analog scale assessing average pain intensity will serve as the primary outcome measure. We will also assess pain interference as a secondary outcome domain. Generalization measures will assess quality of life, sleep quality, and anxiety and depressive symptoms, as well as resting-state electroencephalography and thalamic γ-aminobutyric acid concentration.ResultsThis study was approved by the Human Research Committees of the University of New South Wales in July 2019 and the University of Technology Sydney in January 2020. We plan to begin the trial in October 2020 and expect to publish the results by the end of 2021.ConclusionsThis clinical trial using single-case experimental design methodology has been designed to evaluate the effectiveness of a novel brain-computer interface neuromodulative treatment for people with neuropathic pain after spinal cord injury. Single-case experimental designs are considered a viable alternative approach to randomized clinical trials to identify evidence-based practices in the field of technology-based health interventions when recruitment of large samples is not feasible.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000556943; https://bit.ly/2RY1jRx International Registered Report Identifier (IRRID)PRR1-10.2196/20979

Evaluation of an occupation-based metacognitive intervention targeting awareness, executive function and goal-related outcomes after traumatic brain injury using single-case experimental design methodology

ABSTRACT Self-awareness is commonly impaired after traumatic brain injury and impacts on rehabilitation engagement and community re-integration outcomes. Interventions which incorporate metacognitive strategy instruction have the potential to improve rehabilitation engagement and outcomes. This study aimed to determine whether an occupation-based intervention incorporating metacognitive strategy instruction resulted in goal achievement and improved online awareness and executive function performance during goal-related tasks. A single-case experimental design using a multiple-baseline design across behaviours was used with two participants with severe traumatic brain injury to evaluate the effectiveness of the 6-week intervention. Repeated measures of goal-related performance, percentage of self-corrected errors and executive function were made via independent analysis of video footage and documentation logs. Data analysis involved 2SD bandwidth analysis and overlap data, reliable change index and evaluation of goal achievement across phases. There were improvements in self-corrected errors for one participant, which were maintained. Significant reductions in anxiety (RCI = ±5.98) were evident for both participants, with a significant reduction in stress (RCI = ±7.05) for one participant following the intervention. The occupation-based intervention incorporating metacognitive strategy instruction led to improvements compared to baseline performance in some targeted goals, online awareness and executive function performance during goal-related tasks and reduced stress and anxiety.

Evaluating the Use of Smart Home Technology by People With Brain Impairment: Protocol for a Single-Case Experimental Design.

BackgroundSmart home technologies are emerging as a useful component of support delivery for people with brain impairment. To promote their successful uptake and sustained use, focus on technology support services, including training, is required.ObjectiveThe objective of this paper is to present a systematic smart home technology training approach for people with brain impairment. In addition, the paper outlines a multiple-baseline, single-case experimental design methodology to evaluate training effectiveness.MethodsAdult participants experiencing acquired brain impairment who can provide consent to participate and who live in housing where smart home technology is available will be recruited. Target behaviors will be identified in consultation with each participant based on his or her personal goals for technology use. Target behaviors may include participant knowledge of the number and type of technology functions available, frequency of smart home technology use, and number of function types used. Usage data will be gathered via log-on smart home technology servers. A smart technology digital training package will also be developed and left on a nominated device (smartphone, tablet) with each participant to use during the trial and posttrial, as desired. Measures of the target behavior will be taken throughout the baseline, intervention, and postintervention phases to provide the evidence of impact of the training on the target behaviors and ascertain whether utilization rates are sustained over time. In addition, trial results will be analyzed using structured visual analysis, supplemented with statistical analysis appropriate to single-case methodology.ResultsWhile ascertaining the effectiveness of this training protocol, study results will offer new insights into technology-related training approaches for people with brain impairment. Preliminary data collection has been commenced at one supported housing site, with further scoping work continuing to recruit participants from additional sites.ConclusionsEvaluation evidence will assist in planning for the smart technology set-up as well as training and support services necessary to accompany the provision of new devices and systems.International Registered Report Identifier (IRRID)RR1-10.2196/10451

Using single-case experimental design methodology to evaluate the effects of the ABC method for nursing staff on verbal aggressive behaviour after acquired brain injury

The ABC method is a basic and simplified form of behavioural modification therapy for use by nurses. ABC refers to the identification of Antecedent events, target Behaviours, and Consequent events. A single-case experimental AB design was used to evaluate the effects of the ABC method on a woman diagnosed with olivo-ponto-cerebellar ataxia. Target behaviour was verbal aggressive behaviour during ADL care, assessed at 9 time points immediately before implementation of the ABC method and at 36 time points after implementation. A randomisation test showed a significant treatment effect between the baseline and intervention phases (t = .58, p = .03; ES [Nonoverlap All Pairs] = .62). Visual analysis, however, showed that the target behaviour was still present after implementation of the method and that on some days the nurses even judged the behaviour to be more severe than at baseline. Although the target behaviour was still present after treatment, the ABC method seems to be a promising tool for decreasing problem behaviour in patients with acquired brain injury. It is worth investigating the effects of this method in future studies. When interpreting single-subject data, both visual inspection and statistical analysis are needed to determine whether treatment is effective and whether the effects lead to clinically desirable results.

Single case experimental designs: Introduction to a special issue of Neuropsychological Rehabilitation

This paper introduces the Special Issue of Neuropsychological Rehabilitation on Single Case Experimental Design (SCED) methodology. SCED studies have a long history of use in evaluating behavioural and psychological interventions, but in recent years there has been a resurgence of interest in SCED methodology, driven in part by the development of standards for conducting and reporting SCED studies. Although there is consensus on some aspects of SCED methodology, the question of how SCED data should be analysed remains unresolved. This Special Issues includes two papers discussing aspects of conducting SCED studies, five papers illustrating use of SCED methodology in clinical practice, and nine papers that present different methods of SCED data analysis. A final Discussion paper summarises points of agreement, highlights areas where further clarity is needed, and ends with a set of resources that will assist researchers conduct and analyse SCED studies.

Biofeedback and reinforcement to increase heterosexual arousal in homosexuals

Relatively few procedures exist for developing heterosexual arousal in the treatment of sexual deviation (Barlow, 1973) although several recent studies suggest this is a necessary component of treatment (Feldman and MacCulloch, 1971; Bancroft, 1970; Barlow, 1974). In recent years, biofeedback techniques have been applied to many types of disorders (Blanchard and Young, 1974). Basic to biofeedback technology is the notion that providing a person with feedback (or immediate information) of a bioelectric response enables him to learn (gain) self-control of that response. These responses traditionally have been considered involuntary and include heart rate (Scott et al., 1973a). blood pressure (Benson et al., 1971), stomach acid pH (Welgan. 1972), and electroencephalographic activity (Sterman, 1972), In the present experiments, biofeedback and its attendant technology was applied to the problem of generating heterosexual arousal in homosexual males. Frequently, in biofeedback research, reinforcement has been used in addition to feedback in attempting to teach self-control of a response. In fact, an alternate way of conceptualizing and describing the biofeedback research is in terms of operant conditioning (e.g., Weiss and Engel, 1971: Scott et al., 1973b). In one sense, however, feedback and reinforcement are inextricably confounded: the delivery or non-delivery of a reinforcer provides the S with information about the rightness or wrongness of his response and hence, binary feedback about it. Likewise, if feedback or knowledge of whether the response has reached a criterion level or not is effective in leading to a change in the response, then feedback functions as a reinforcer. Reinforcement, however, may be viewed as providing both information about the response (feedback) plus an incentive to change it in the desired direction in addition to any incentive provided by successful performance of a task. Thus, if one provides Ss with a separate, functionally defined reinforcer in such a way that no additional information about the response is conveyed, it becomes possible to detect additive effects of reinforcement over feedback effects. Such was the second purpose of this study. Several recent analogue experiments with volunteers have reported success in modifying erections through feedback and/or reinforcement. Price (1973) found that heterosexual volunteers who received analogue visual feedback as well as binary feedback, provided by a colored light once the needle had passed a pre-set criterion, showed a shorter latency to peak erection and maintained criterion erection longer than a control group receiving no feedback. Both groups were listening to erotic audio tapes. Rosen (1973) demonstrated significant suppression of tumescence in a group of heterosexual volunteers provided with response contingent signal lights. A group receiving non-contingent feedback did not show this effect. In a technical paper, Laws and Pawlowski (1973) have suggested audio feedback of tumescence as a treatment for deficits in sexual arousal. In the clinic, Harbison, Quinn and McAllister (1970), in an uncontrolled case study, reported increasing heterosexual responsiveness in homosexuals through reinforcement of erection. In one of their homosexual patients they were able, over a long series of trials, to increase erection to a heterosexual stimulus (female slide) through rewarding progressively larger responses with sips of iced lime after the patient was water deprived. In addition to the reinforcement, this S was given feedback, of sorts, in that a light was flashed for each successful trial. A second homosexual patient was similarly rewarded for maintaining progressively longer and clearer fantasies of heterosexual behavior. Since other treatments were also applied and no experimental analysis was performed, it is not possible to evaluate the effectiveness of the procedure. In the present experiment the separate effects of feedback and reinforcement to increase heterosexual arousal in homosexuals was experimentally evaluated using single case experimental design methodology (Barlow and Hersen, 1973). Since each experiment was somewhat different in design and purpose, each will be described separately.