Successful Behavioral Interventions Research Articles

The value of social-cognitive theory to reducing preschool TV viewing: A pilot randomized trial

ObjectiveTo (a) reduce the total amount of television viewing to which preschool children are exposed; and (b) shift the balance of exposure away from commercial television toward educational content. MethodRandomized controlled clinical trial. Data collected in 2007; analyzed 2008–2011. Participants were 67 English-speaking families in Seattle with a preschool-aged child exposed to more than 90min of television viewing on average per day. A case manager for each group used in-person conferences, monthly newsletters, and e-mail contact to motivate behavior change around child television viewing (intervention) or child safety (control). ResultsCompared to those in the control group, families randomized to the intervention group experienced a significant reduction by 37minutes/day in total viewing time (95% CI: 5.6–68.7), including a marginally significant reduction by 29minutes/day in viewing of commercial content (95% CI: −4.6–63). Compared to those in the control group, those in the intervention group experienced a positive change in outcome expectations. There were no significant changes in self-efficacy or volitional control. An advance in stage-of-change was marginally significant. ConclusionsTargeting commercial TV viewing may prove a successful behavioral intervention to achieve public health goals in this population.

The Impact of Behavioral Feeding Intervention on Health Care Utilization

This study examined health care utilization pre- and post-referral to a behaviorally based treatment program for feeding difficulties in children. Physician contacts and associated costs for a feeding clinic group (n = 490) and a group of matched population controls (n = 1,548) were examined across a 3-year period. Children with feeding difficulties had an increased frequency of physician visits and higher costs compared to controls. A subsample (n = 86) of clinic children revealed that successful behavioral feeding intervention resulted in a change in health care utilization, as demonstrated by a reduction in physician visits.

Increasing and Supporting the Participation of Persons of Color Living with HIV/AIDS in AIDS Clinical Trials

Persons living with HIV/AIDS (PLHA) of color are under-represented in AIDS clinical trials (ACTs), which may limit the generalizability of research findings and denies many individuals access to high levels of care and new treatments available through ACTs. Disproportionately low rates of recruitment in health care settings and by providers are a major barrier to ACTs for this group. Moreover, PLHA of color are more likely than their white peers to decline to participate, mainly due to fear and mistrust (although willingness is also high), negative social norms about ACTs, and difficulty navigating the unfamiliar ACT system. We describe a small number of successful behavioral and structural interventions to increase the participation of PLHA of color in screening for and enrollment into ACTs. HIV care settings, clinical trials sites, and trial sponsors are uniquely positioned to develop procedures, supports, and trials to increase the proportion of PLHA of color in ACTs.

Feasibility of Adapting Multisystemic Therapy to Improve Illness Management Behaviors and Reduce Asthma Morbidity in High Risk African American Youth: A Case Series

African-American adolescents have the highest rates of asthma morbidity and mortality, yet there are few successful behavioral interventions to improve illness management for this group. Mental health providers have an opportunity to expand their services and impact by targeting adolescents with poor asthma management. We describe the adaptation of Multisystemic Therapy (MST), an intensive, home and community-based treatment originally used with antisocial youth, for improving asthma management. We present a case study to illustrate the treatment model. Feasibility was demonstrated with eight African American adolescents with chronic, persistent asthma, suggesting that further evaluation of MST for youth with asthma and poor illness management is warranted.

Mediators of a successful web‐based smokeless tobacco cessation program

To examine self-efficacy and program exposure as possible mediators observed treatment effects for a web-based tobacco cessation intervention. The ChewFree trial used a two-arm design to compare tobacco abstinence at both the 3- and 6-month follow-up for participants randomized to either an enhanced intervention condition or a basic information-only control condition. Internet in US and Canada. Our secondary analyses focused upon 402 participants who visited the web-based program at least once, whose baseline self-efficacy rating showed room for improvement, who reported that they were still using tobacco at the 6-week assessment, and for whom both 3- and 6-month follow-up data were available. An enhanced web-based behavioral smokeless tobacco cessation intervention delivered program content using text, interactive activities, testimonial videos and an ask-an-expert forum and a peer forum. The basic control condition delivered tobacco cessation content using static text only. Change in self-efficacy and program exposure from baseline to 6 weeks were tested as simple and multiple mediators on the effect of treatment condition on point-prevalence tobacco abstinence measured at 3- and 6-month follow-up. While both participant self-efficacy and program exposure satisfied the requirements for simple mediation, only self-efficacy emerged as a mediator when we used the more robust test of multiple mediation. Results confirm the importance of self-efficacy change as a probable underlying mechanism in a successful web-based behavioral intervention. While program exposure was found to be a simple mediator of tobacco abstinence, it failed to emerge as a mediator when tested with self-efficacy change in a multiple mediator test suggesting that self-efficacy and program exposure share a complex, possibly reciprocal relationship with the tobacco abstinence outcome. Our results underscore the utility of searching for mediators in research on web-based interventions.

S17-7 Changing Sexual Behaviors to Prevent Sexually Transmitted Infections : Creation of a Successful Behavioral Intervention(ISPOG2007)

S17-7 Changing Sexual Behaviors to Prevent Sexually Transmitted Infections : Creation of a Successful Behavioral Intervention(ISPOG2007)

Habit Reversal Treatment of Tic Disorders

One of the most commonly reported and successful behavioral interventions for tic disorders is habit reversal (HR). Several narrative literature reviews have adequately summarized the outcomes of these studies. The purpose of this article was to review studies that used HR to treat tics in terms of their methodological characteristics and rigor. Guidelines developed by the Task Force on Promotion and Dissemination of Psychological Procedures were used to evaluate the state of the literature. From an initial database that included 29 studies, 12 were included in the final analysis. Results indicate that although research has been conducted in this area for almost three decades, the majority of studies contain considerable methodological shortcomings. Based on the Task Force guidelines, the existing literature on the use of HR to treat tics can currently be classified as probably efficacious, and it almost meets the criteria for the well-established classification. Directions for future research are discussed.

A Simple Framework to Describe What Works Best: Improving Awareness, Enhancing Motivation, Building Skills, and Providing Opportunity

Behavior change is often complex, conceptually challenging, and open to dispute as to the effectiveness of specific interventions. Defining "what works best" in health behavior change discussions is often problematic and can be contentious. In this issue of The Art of Health Promotion the author offers a simple framework to determine what is likely to work best in producing long-term behavior change. The article identifies four components that are highly associated with successful behavior change. These include improving awareness, enhancing motivation, building skills, and providing opportunity for practicing the new skills. This simple framework is likely to be a very useful tool in communicating the essentials of successful behavioral intervention to all major stakeholders in health promotion.

Using patient risk indicators to plan prevention strategies in the clinical care setting.

Successful behavioral interventions to promote safe sex must be tailored to the sexual behaviors and relationships of individual patients. The aim of this study is to examine the distribution of unprotected anal and vaginal sex (UAV) and nondisclosure (ND) among categories of HIV-positive men and women based on relationship factors. These factors can be easily assessed and used as a basis for tailoring safer sex counseling in the clinic setting. Eight hundred forty HIV-positive persons who were sexually active and attending 1 of 6 clinics in California were surveyed. Participants were categorized on the basis of numbers of partners, sexual orientation, type of relationship, and partner serostatus. Self-reported UAV, ND, and duration of the relationship were reported for each category and were examined. UAV was lower for those with 1 partner (26%) as compared with those with 2 or more partners (50%). ND was also lower for those with 1 partner (20%) as compared with those with 2 or more partners (60%). For those with 1 main partner, we found no significant differences in UAV by sexual orientation. UAV with seronegative main partners ranged from 16% to 20%, whereas UAV with seropositive partners ranged from 37% to 46%. Among men who have sex with men with 2 or more partners, relationships were more likely to be casual, of short duration, and to have higher levels of UAV and ND. The number of sex partners, type of relationship, and perceived HIV serostatus of a partner influence sexual behaviors and may be an efficient and effective basis for tailoring prevention messages.

Testing Combined Pharmacotherapies and Behavioral Interventions in Alcohol Dependence: Rationale and Methods

Increasing knowledge about effective therapies for alcohol dependence calls for new research designs to examine treatment interactions between pharmacotherapies and behavioral interventions. In 1997, the National Institute on Alcohol Abuse and Alcoholism recruited 11 sites and a coordinating center for a large‐scale (1,375 subjects), randomized placebo controlled trial to test 16 weeks of active treatment using naltrexone and acamprosate alone and in combination. Most participants receive 9 brief sessions delivered by medically trained providers to promote sobriety and enhance medication adherence (Medical Management, MM). Half the participants are also randomized to individualized psychotherapy (up to 20 sessions of Combined Behavioral Intervention, CBI), integrating elements of the successful behavioral interventions from Project MATCH. COMBINE seeks to evaluate the efficacy of the two most promising medications (naltrexone and acamprosate) both singly and together, when combined with different intensities of behavioral therapies. COMBINE incorporates a number of innovative design aspects, including a no‐pill psychotherapy‐alone condition, behavioral interventions that are both manual‐guided and individualized, and pharmacotherapy dosing that is greater than in some previous trials. Two COMBINE pilot studies demonstrate the safety and acceptability of the combination pharmacotherapy dosing, and the feasibility of implementing the manualized behavioral interventions. This paper introduces COMBINE's goals, methods and analytic strategies, and their potential to improve multimodal treatment selection.

Learning from clients: an opportunity for sexually transmitted disease programs.

This article summarizes sexually transmitted disease (STD) knowledge, health care-seeking behaviors, and perceived advantages to seeking care from the perspective of 397 STD clinic clients interviewed between 1997 and 1999 in three northeastern cities. More than half reported a prior STD. Mean days delay in seeking treatment was 10.8. Reasons for delay included lack of knowledge especially about symptoms (44%) and inconvenience, especially clinic hours (46%). Major disadvantages to receiving care centered around embarrassment and stress (24%). Programs need to develop more intensive counseling for repeat clients, offer more flexible hours, address sources of stress inherent in their services, and develop better marketing strategies. Successful behavioral interventions, behavioral training, and creative approaches from the popular literature may be helpful.

Urban tree-planting programs — A model for encouraging environmentally protective behavior

Efforts to increase environmentally sound behaviors and practices have in the past often focussed on consciousness-raising and attitude change. Research indicates that such efforts are less effective than interventions designed to make environmentally sound behaviors easier to engage in, or to make personal advantages resulting from such behaviors more clear to individuals. Four nonprofit tree planting organizations were studied as examples of successful environmental interventions. From these studies, as well as a review of the literature, several principles underlying successful behavioral interventions are identified. Implications of these principles for future environmental programs are discussed.

Manualized behavior therapy: Merits and challenges

Treatment manuals have been hailed as an important breakthrough in the development, evaluation, and dissemination of empirically validated therapies. Yet manualized behavior therapy has also been criticized because (a) practice involves the application of validated principles of behavior rather than the application of fixed strategies, and (b) successful behavioral interventions must supposedly be based on an idiographic functional problem analysis and tailored to each individual patient. This article evaluates the relative merits, potential limitations, and misconceptions about the use of manuals. We conclude that individualizing treatment and manual use are not mutually exclusive and propose that manuals be used in a flexible theory-driven fashion guided by empirically tested clinical decision rules.

Prediction of outcome in behaviorally based insomnia treatments

Factors related to successful behavioral intervention for individuals with insomnia are not well understood. In this study we employed the Neuroticism, Extraversion and Openness (NEO) Personality Inventory, to predict successful treatment outcome. Two behavioral treatments for insomnia, sleep restriction therapy (SRT) and relaxation training (RT) were employed in 32 elderly insomniacs. Following two baseline weeks, subjects underwent four weeks of individual treatment. Daily telephone call-ins generated data on sleep times and sleep latency. Follow-up occurred three months after the end of treatment. Results indicated that subjects showing the greatest improvement in total sleep time with both treatments were more traditional, conventional and rigid. Improvement in sleep onset latency was unrelated to NEO Scores. SRT appeared to be more effective for increasing total sleep time in these older subjects.

The Role of Performance Profiling in Cognitive Behavioral Interventions in Sport

This paper reports a case study of a successful cognitive behavioral intervention using performance profiling. The subject, a top-10 female racket sport player, had a problem with her temperament on court, becoming angry and frustrated in pressure situations. Performance profiling was used for three major purposes: (a) to aid the sport psychologist in identifying an appropriate psychological intervention, (b) to maximize the performer’s self-motivation to partake in and adhere to the intervention, and (c) to monitor any changes during the intervention. A multimodal stress management approach was adopted using a combination of component parts from the available packages. The performance profiling technique showed significant improvements in the performer’s ability to cope with pressure situations 3 and 6 months after the intervention.

New possibilities in safety performance and the control of workers' compensation costs

This article describes successful behavioral interventions that improved safety performance and reduced workers' compensation costs in two corporations. The development of a four part program that: (1) shifted the paradigm for positive performance by workers and managers, (2) strengthened the community of work, (3) managed the crises of accidents, and (4) accelerated the return of injured employees to meaningful work is presented. In the two companies, lost time accidents were reduced by 95% and 87%, and accident costs were reduced by 90% and 70%, respectively. The results are discussed in terms of the critical roles played and choices made by managers in establishing a meaningful work culture, and the ethics which guide workers' and managers' behavior in decisions related to the use and abuse of the workers' compensation system.

Aversion conditioning in response to cancer and cancer treatment

Cancer patients appear to be at high risk for the development of conditioned responses that can contribute to the discomfort they experience as a consequence of their treatments as well as their disease. Chemotherapy treatments which induce nausea and vomiting can be associated with the acquisition of aversions to novel and familiar foods. Such treatments can also lead to the conditioning of anticipatory symptoms of nausea and vomiting. The disease itself can lead to the development of food aversions and appetite problems. An understanding of the learning processes underlying the generation of these symptoms can contribute importantly to the development of successful behavioral interventions.

Sexual Dysfunction in an Aged Married Couple

The literature on the treatment of sexual dysfunctions is based on clinical findings using younger clients. Although there are similarities between younger and older sexually dysfunctional adults, aging and cohort differences may affect the course of treatment. Few examples have been presented to date which identify special treatment problems of older adults. This case study describes a successful behavioral therapeutic intervention used in the treatment of a sexual dysfunction in an older married couple.

Behavioral assessment and treatment of child migraine: implications for clinical research and practice.

SYNOPSISBehavioral assessment and treatment strategies for adult migraine have gained wide acceptance during the past decade. However, very little research exists on the use of behavioral methods for child migraine. The present paper reviews clinical research and practice in the behavioral assessment and treatment of child migraine. Based on the available medical literature, it appears thatchild migraine closely parallels adult migraine, excepting for some neurological signs, a higher proportion of affected males, and the greater prominence of gastrointestinal upset characterizing the former. Assessment methods that have proven useful with adult migraineurs, including interview data and headache diaries, have yet to be validated with a child population. Several behavioral and social validation measures are proposed as additional assessment strategies for child migraine. Although recent studies evaluating the use of relaxation, biofeedback, and other behavioral approaches for child migraine have been encouraging, methodological shortcomings in these studies make the drawing of firm conclusions premature. It is concluded that child migraine presents a very promising research domain in light of recent successes in therapeutic trials with children and the background of successful behavioral interventions established with adults.