Resurgence of destructive behavior following decreases in alternative reinforcement: A prospective analysis

Basic and retrospective translational research has shown that the magnitude of resurgence is determined by the size of the decrease in alternative reinforcement, with larger decreases producing more resurgence. However, this finding has not been evaluated prospectively with a clinical population. In Experiment 1, five participants experienced a fixed progression of reinforcement schedule-thinning steps during treatment of their destructive behavior. Resurgence occurred infrequently across steps and participants, and when resurgence did occur, its clinical meaningfulness was often minimal. In Experiment 2, five new participants experienced these same schedule-thinning steps but in a counterbalanced order. Resurgence occurred most often and was generally largest with larger decreases in alternative reinforcement programmed earlier in the evaluation. Large decreases in alternative reinforcement may be more problematic clinically when they occur earlier in treatment. Whether larger transitions can be recommended in the clinic following the success of smaller ones will require additional research.

Retrospective consecutive controlled case series of outcomes for functional analyses of severe destructive behavior

Functional analysis methods allow clinicians to determine the variable(s) that maintain destructive behavior. Previous reviews of functional analysis outcomes have included large samples of published and unpublished data sets (i.e., clinical samples). The purpose of this review was to conduct a large retrospective consecutive controlled case series of clinical functional analyses. We sought to identify the prevalence of differentiation, procedural modifications for undifferentiated and differentiated cases, and identified function(s) of destructive behavior. In addition, we extended the existing literature by determining whether functional analysis differentiation and function varied when single or multiple behavior topographies were consequated in the functional analysis. We discuss our findings considering previously published functional analysis reviews, provide avenues for future research, and offer suggestions for clinical practice.

Relative preference for distinct reinforcers maintaining destructive behavior

The literature offers few recommendations for sequencing exposure to treatment conditions with individuals with multiply maintained destructive behavior. Identifying relative preference for the functional reinforcers maintaining destructive behavior may be one means of guiding that decision. The present study presents a preliminary attempt at developing a robust relative preference and reinforcer assessment for individuals with multiply maintained destructive behavior. Guided and free-choice trials were implemented in which participants chose between two multiple-schedule arrangements, each of which programmed signaled periods of isolated reinforcer availability and unavailability. Consistent participant choice and responding during free-choice trials was then used to thin the corresponding schedule of reinforcement. The results demonstrated a strong preference for one of the two functional reinforcers for all four participants, yet preferences differed across participants and were not well predicted by responding in prior analyses.

Evaluations of heart rate during functional analyses of destructive behavior

Previous research has examined the predictive validity of heart rate on destructive behavior; however, such research has yet to improve clinical practice or enhance our understanding of the relation between physiology and destructive behavior. The purpose of this study was to examine the predictive validity of heart rate on varying topographies and functions of destructive behavior while controlling antecedent and consequent events through functional analysis. We first demonstrated the reliability of the Polar H10 heart rate monitor and assessed the feasibility of its use in simulated functional analysis sessions. However, across four consecutively enrolled patients, heart rate was not found to be a reliable predictor of destructive behavior, regardless of its topography or function. Instead, functional reinforcer presence and absence was sufficient to predict socially reinforced destructive behavior. This study may provide a framework for the future assessment of other biological measures in relation to destructive behavior occurrence and nonoccurrence.

Further evaluation of treatment duration on the resurgence of destructive behavior

Translation of promising procedures for mitigating treatment relapse has received considerable attention recently from researchers across the basic-applied continuum. One procedure that has demonstrated mixed support involves increasing the duration of treatment as a strategy for blunting resurgence. In a recent translational study, Greer et al. (2020) failed to detect a mitigation effect of increased treatment duration on the resurgence of destructive behavior. However, design limitations may have been responsible. The present study corrected these limitations by (a) employing a sequential design to decrease the possibility of multiple-treatment interference, (b) evaluating more treatment durations, (c) arranging treatments of fixed durations, and (d) conducting treatments of more extreme duration in a different clinical sample. Despite these improvements in experimental rigor and the testing of more extreme boundary conditions, the present study also failed to detect a mitigation effect of increased treatment duration. Likely explanations are discussed.

Effect of a provincial feline onychectomy ban on cat intake and euthanasia in a British Columbia animal shelter system

OBJECTIVES

The aim of this study was to determine whether there was an increase in cat relinquishment for destructive scratching behavior, a change in overall feline surrender intake and euthanasia, or a change in average length of stay in a British Columbia shelter system after provincial legislation banning elective onychectomy.

METHODS

Records of cats admitted to the British Columbia Society for the Prevention of Cruelty to Animals in the 36 months prior to (1 May 2015-30 April 2018, n = 41,157) and after (1 May 2018-30 April 2021, n = 33,430) the provincial ban on elective onychectomy were reviewed. Total intake numbers, euthanasia and length of stay were descriptively compared between periods. Proportions of cats and kittens surrendered for destructive scratching, as well as the proportion of cats and kittens surrendered with an owner request for euthanasia, were compared using two-sample z-tests of proportions.

RESULTS

Destructive behavior was found to be an uncommon reason for surrender (0.18% of surrendered cats) during the study period. There was no statistically significant difference in the number of cats surrendered for destructive scratching behavior (z = -1.89, P >0.05) after the provincial ban on elective onychectomy. On the contrary, the proportion of owner-requested euthanasias decreased after the ban (z = 3.90, P <0.001). The total number of cats surrendered, the shelter live release rate and average length of stay all remained stable or improved following the ban, though causation could not be determined.

CONCLUSIONS AND RELEVANCE

The findings in this study suggest that legislation banning elective onychectomy does not increase the risk of feline shelter relinquishment - for destructive behavior or overall - and is unlikely to have a significant effect on shelter euthanasia or length of stay.

On the scope and characteristics of relapse when treating severe destructive behavior

Prior studies on treatment relapse have typically examined the prevalence of resurgence or renewal of target behavior (e.g., destructive behavior) in isolation. This study analyzed both types of relapse during 25 consecutive treatments involving functional communication training during worsening reinforcement conditions for alternative behavior (i.e., schedule thinning) or following context changes. We also examined disruption of alternative behavior (i.e., functional communication requests, compliance). Resurgence and renewal of destructive behavior occurred in 76% and 69% of treatments, respectively, and in approximately a third of changes in reinforcement or context. Relapse of destructive behavior predicted alternative-response disruption and vice versa; the co-occurrence of these two events always exceeded the background probabilities of either event occurring in isolation. General reductions in treatment efficacy occurred across changes in reinforcement or context, with no apparent decrease in likelihood in later transitions. We discuss implications of our findings with respect to future studies examining treatment durability.

Destructive behavior increases as a function of reductions in alternative reinforcement during schedule thinning: A retrospective quantitative analysis

The behavioral processes determining the magnitude of the resurgence of destructive behavior during reinforcement schedule thinning have yet to be described, despite an uptick in prevalence research on the topic. As predicted by Resurgence as Choice theory, recent animal research has found that resurgence increases with the magnitude of a downshift in alternative reinforcement. Here we reanalyze the data from 2 recent prevalence studies to determine whether the size of the decrease in alternative reinforcement availability predicts the magnitude of resurgence in the clinic. Results from this retrospective analysis suggest that resurgence of destructive behavior increases significantly with decreases in the availability of alternative reinforcement. Implications for future research and translations of theoretical analyses to the clinic are discussed.

Solidarity in a Community of Nursing Colleagues

Introduction

Several concepts have been used to describe the qualities of communities of nursing colleagues. Nonetheless, few studies have shed light on nursing communities by drawing on the concept of solidarity.

Objective

To explore solidarity among a community of nursing colleagues.

Methods

A qualitative research design with a reflective life world approach was selected. This study reused data from a larger Norwegian empirical study. The data from the original study consisted of qualitative interviews and follow-up interviews with 13 nurses (RNs). The research context was municipality and specialist health services. A secondary data analysis was conducted. The study was based on the SRQR reporting guidelines.

Results

The results were formulated under two themes: 1) having indispensable relationships and 2) encountering a relative absence of sympathy.

Conclusion

A sense of community among nursing colleagues seems to rely on solidarity: whatever affects one nurse affects another. The solidarity that arose from the content of commonalities involved maintaining indispensable relationships with nursing colleagues by supporting and aiding them and simultaneously enduring a relative absence of sympathy. Solidarity among the community in this study was not a peripheral concept of the general notion of solidarity, implying that the commonalities within the collegial relationships were ambiguous and could shift from something good to something relatively good and vice versa. Such a shift was evidenced by nurses’ experiences of their community.

Resurgence following differential reinforcement of alternative behavior implemented with and without extinction

In the clinic, differential reinforcement of alternative behavior (DRA) often involves programming extinction for destructive behavior while reinforcing an alternative form of communication (e.g., a functional communication response); however, implementing extinction can be unsafe or impractical under some circumstances. Quantitative theories of resurgence (i.e., Behavioral Momentum Theory and Resurgence as Choice) predict differences in the efficacy of treatments that do and do not involve extinction of target responding when reinforcement conditions maintaining alternative responding worsen. We tested these predictions by examining resurgence following two DRA conditions in which we equated rates of reinforcement. In DRA without extinction, target and alternative behavior produced reinforcement. In DRA with extinction plus noncontingent reinforcement, only alternative behavior produced reinforcement. We conducted this study in a reverse-translation sequence, first with participants who engaged in destructive behavior (Experiment 1) and then in a laboratory setting with rats (Experiment 2). Across both experiments, we observed proportionally lower levels of target responding during and following the DRA condition that arranged extinction for the target response. However, levels of resurgence were similar following both arrangements.

A preliminary evaluation of treatment duration on the resurgence of destructive behavior

Quantitative models of resurgence (e.g., Behavioral Momentum Theory, Resurgence as Choice) suggest that resurgence is partly a function of the duration of extinction exposure, with longer histories of extinction producing less resurgence. This prediction is supported by some laboratory research and has been partially supported by clinical translations that did not isolate the effects of extinction exposure prior to testing for resurgence. The degree to which different histories of extinction impact the likelihood of treatment relapse in therapeutic applications of differential reinforcement is of great interest to the clinical community, including insurance carriers and other financial providers. In the present study, we isolated the effects of extinction history for severe destructive behavior across 6 participants referred for treatment services and examined resurgence of destructive behavior when alternative reinforcement terminated. Our within-subject evaluation showed no difference in the level of resurgence or persistence of destructive behavior following short and long exposures to differential reinforcement with extinction. We discuss our failure to replicate in relation to experimental-design considerations for investigating this and other relapse phenomena in future research with clinical populations.

Mitigating resurgence of destructive behavior using the discriminative stimuli of a multiple schedule

Results of several recent translational studies have suggested that correlating contextual or discriminative stimuli with the delivery and withholding of reinforcement for the functional communication response (FCR) may mitigate resurgence of destructive behavior, but few, if any, have isolated the effects of those stimuli. In the present study, we first trained the FCR, brought it under stimulus control of a multiple schedule, and thinned its reinforcement schedule in one stimulus context. Next, we conducted resurgence evaluations (i.e., baseline, functional communication training [FCT], extinction challenge) in two novel contexts to test the effects of the discriminative stimuli on resurgence. We programmed one context to include the (a) S^D during the FCT phase to signal the availability of reinforcement for the FCR and (b) S^Δ during a subsequent extinction challenge to signal the unavailability of reinforcement for the FCR. The other context did not include the S^D during the FCT phase, nor the S^Δ during the extinction challenge. We expected to see greater persistence of the FCR in the context that included the S^D during FCT and less persistence of the FCR and less resurgence of destructive behavior in the context that included the S^Δ during the extinction challenge. Obtained results confirmed this latter prediction, but we observed no reliable difference when the S^D was present or absent during the FCT phase. Our results have relevance for practitioners in that they provide further empirical support for the use of discriminative stimuli when treating destructive behavior.

Using Schedule-Correlated Stimuli During Functional Communication Training to Promote the Rapid Transfer of Treatment Effects

Prior research has shown that bringing functional communication responses under the discriminative control of schedule-correlated stimuli facilitates rapid reinforcement schedule thinning and the transfer of functional communication training (FCT) treatment effects to other therapists and settings. In Experiment 1, we extended this body of research by rapidly transferring FCT treatment effects to a caregiver, despite the caregiver's unique and lengthy history of reinforcement of the child's destructive behavior. In Experiment 2, we evaluated the degree to which FCT treatment effects transferred to another participant's caregivers when the caregivers implemented FCT with and without schedule-correlated stimuli. Rapid transfer of FCT treatment effects occurred only when caregivers used the schedule-correlated stimuli. We discuss the use of schedule-correlated stimuli within FCT procedures as a method of programming for generalization when extending treatment to caregivers.

Evaluating competing activities to enhance functional communication training during reinforcement schedule thinning

Arranging periods in which requests for reinforcement are denied in a multiple schedule may result in increased destructive behavior during these periods for individuals who receive functional communication training (FCT) as treatment for severe destructive behavior. Providing access to competing activities during periods of reinforcer unavailability has been shown to minimize destructive behavior. We evaluated methods to identify effective competing activities for use when thinning reinforcement availability in a multiple schedule and compared competing activities embedded within the multiple schedule using an alternating-treatments design. Results suggested at least one competing activity facilitated favorable treatment outcomes for each participant. We discuss building on this empirical approach to identify effective competing activities for use during reinforcement schedule thinning.

Minimizing resurgence of destructive behavior using behavioral momentum theory

The resurgence of destructive behavior can occur during functional communication training (FCT) if the alternative response contacts a challenge (e.g., extinction). Behavioral momentum theory (BMT) suggests that refinements to FCT could mitigate resurgence of destructive behavior during periods of extinction. Following a functional analysis and treatment with FCT, we combined three refinements to FCT (i.e., the use of a lean schedule of reinforcement for destructive behavior during baseline, a lean schedule for the alternative response during FCT, and an increase in the duration of treatment) and compared the magnitude of resurgence relative to a condition in which FCT was implemented in a traditional manner. Results suggested that the combination of these three refinements to FCT was successful in decreasing the resurgence of destructive behavior during an extinction challenge. We discuss the implications of these findings, as well as areas for future research.

On the predictive validity of behavioral momentum theory for mitigating resurgence of problem behavior

We summarize the results of four recent translational studies from our lab that used the predictions of behavioral momentum theory to inform the development of more durable treatments for destructive behavior. Treatments informed by behavioral momentum theory generally showed better suppression of target responding during an extinction challenge than did a comparison treatment. We reanalyze data from each of the four studies to show that this general finding is apparent both at the aggregate (i.e., proportion of baseline response rates averaged across participants) and within participant (i.e., percentage reduction in proportion of baseline response rates, difference in raw response rates during the extinction challenge). Interestingly, participants who experienced multiple cycles of the extinction challenge generally showed less differentiation in target responding between the treatment informed by behavioral momentum theory and the comparison treatment. Overall results suggest that applications of behavioral momentum theory can substantially improve the durability of common treatments for destructive behavior.

A preliminary investigation on improving functional communication training by mitigating resurgence of destructive behavior

Despite the effectiveness and widespread use of functional communication training (FCT), resurgence of destructive behavior can occur if the functional communication response (FCR) contacts a challenge, such as lapses in treatment integrity. We evaluated a method to mitigate resurgence by conducting FCT using a multiple schedule of reinforcement prior to extinction. After functional analyses of 2 boys' destructive behavior and treatment with FCT (Study 1), we compared levels of resurgence during an extinction challenge either after a typical FCT sequence or after exposure to schedule thinning in the context of a multiple-schedule arrangement (Study 2). Results for both participants suggested that schedule thinning using discriminative stimuli in a multiple schedule mitigated the resurgence of destructive behavior.

Functional communication training during reinforcement schedule thinning: An analysis of 25 applications

Two principal goals of functional communication training (FCT) are (a) to eliminate destructive behavior and (b) to establish a more acceptable, yet functionally equivalent, communication response (FCR). A related and critically important goal is to thin the schedule of reinforcement for the FCR to levels that can be reasonably managed by caregivers. Researchers have described several approaches to thinning FCT reinforcement schedules. We summarize the results of 25 consecutive applications (among 20 cases) in which schedule-thinning procedures employed discriminative stimuli to signal when the FCR would and would not produce reinforcement (i.e., using multiple schedules, response restriction, or chained schedules). Results suggest that schedule-thinning procedures that use discriminative stimuli can maintain the effectiveness of FCT while they minimize the need for punishment or other supplemental procedures.

An evaluation of persistence of treatment effects during long-term treatment of destructive behavior

Eight young children who displayed destructive behavior maintained, at least in part, by negative reinforcement received long-term functional communication training (FCT). During FCT, the children completed a portion of a task and then touched a communication card attached to a microswitch to obtain brief breaks. Prior to and intermittently throughout FCT, extinction probes were conducted within a withdrawal design in which task completion, manding, and destructive behavior were placed on extinction to evaluate the relative persistence of appropriate and destructive behavior over the course of treatment. FCT continued until appropriate behavior persisted and destructive behavior failed to recur at baseline levels during extinction probes. The completion of FCT was followed by four challenges to the persistence of treatment effects conducted within mixed- or multiple-schedule designs: (a) extended extinction sessions (from 5 to 15 min), (b) introduction of a novel task, (c) removal of the microswitch and communication card, and (d) a mixed schedule of reinforcement in which both appropriate and destructive behavior produced reinforcement. The results showed that although FCT often resulted in quick reductions in destructive behavior and increases in appropriate behavior, destructive behavior often recurred during the extinction probes conducted during the initial treatment. When the effects of treatment persisted during the extinction probes, the remaining challenges to treatment effects resulted in only mild to moderate disruptions in behavior. These results are consistent with the quantitative predictions of behavioral momentum theory and may provide an alternative definition of maintenance as constituting behavioral persistence.