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Stimulus Control (stimulus + control)
Selected AbstractsBehavioural treatment of urinary incontinence and encopresis in children with learning disabilities: transfer of stimulus controlDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2000Linda Smith MAMSc Clinical Psychologist Urinary and faecal incontinence present a considerable problem in people with learning disabilities, despite the general effectiveness of behavioural techniques in continence training. Children with learning disabilities and obsessional behaviour may be particularly resistant to toilet training, even where relatively cognitively able, and often despite a substantial degree of control over their eliminatory functions. Their resistance may be more appropriately regarded as a challenging behaviour and their incontinence better explained by factors other than a simple failure to learn. A 'stimulus-control'hypothesis proposes that the child's nappy (diaper) /potty/underwear has developed strong stimulus control over the elimination response. This report describes three case studies in which treatment-resistant children, aged between 8 and 12 years, with mild or moderate learning disabilities, were successfully treated for nappy-dependent nocturnal encopresis or diurnal urinary incontinence. The children were routine case referrals for whom previous attempts to train bowel or bladder control had failed. Behavioural techniques, such as 'shaping'(gradually increasing the proximity to the toilet),,fading'(reducing the presence of the nappy), and rewards for eliminating, effected successful transfer of stimulus control over elimination from nappy to toilet. Treatment times varied, depending on the degree of the child's obsession and resistance to change. [source] Late-life insomnia: A reviewGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2009Arne Fetveit Aging is associated with substantial changes in sleep patterns, which are almost always negative in nature. Typical findings in the elderly include a reduction in the deeper stages of sleep and a profound increase in the fragmentation of nighttime sleep by periods of wakefulness. The prevalence of specific sleep disorders increases with age, such as a phase advance in the normal circadian sleep cycle, restless legs syndrome, and obstructive sleep apnea, which is increasingly seen among older individuals and is significantly associated with cardio- and cerebrovascular disease as well as cognitive impairment. Elderly patients with sleep disturbances are often considered difficult to treat; yet, they are among the groups with the greatest need of treatment. Management of sleep disturbances begins with recognition and adequate assessment. Hypnotic drugs have clearly been shown to improve subjective and objective sleep measures in short-term situations, but their role in chronic insomnia still remains to be further defined by research evidence. Non-pharmacological treatments, particularly stimulus control and sleep restriction, are effective for conditioned aspects of insomnia and are associated with a stable, long-term improvement in sleep. This review delineates the common causes of disordered sleep in older individuals, and effective diagnostic approaches and treatments for these conditions. [source] Behavioral Facilitation of Medical Treatment of Headache: Implications of Noncompliance and Strategies for Improving AdherenceHEADACHE, Issue 2006Jeanetta C. Rains PhD Clinical recommendations were gleaned from a review of treatment adherence published in the regular issue of Headache (released in tandem with this supplement). The recommendations include: (1) Nonadherence is prevalent among headache patients, undermines treatment efficacy, and should be considered as a treatment variable; (2) Calling patients to remind them of appointments and recalling those who miss a scheduled appointment are fundamentally the most cost-effective adherence-enhancing strategies, insofar as failed appointment-keeping acts as a ceiling on all future treatment and adherence efforts; (3) Simplified and tailored medication regimens improve adherence (eg, minimized number of medications and dosings, fixed-dose combinations, cue-dose training, stimulus control); (4) Screening and management of psychiatric comorbidities, especially depression and anxiety, is encouraged; (5) The concept of self-efficacy as a modifiable psychological process often can be employed to predict and improve adherence. [source] Review of systematic reviews about the efficacy of non-pharmacological interventions to improve sleep quality in insomniaINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2009Gerrit J De Niet MSc RN Abstract Background, Insomnia is a very common condition in various populations. Non-pharmacological interventions might offer (safe) alternatives for hypnotics. Aim, To evaluate the evidence for efficacy from systematic reviews about non-pharmacological interventions to improve sleep quality in insomnia by a systematic review of systematic reviews and meta-analyses. Search strategy, Search strategies were conducted in the Database of Abstracts of Reviews of Effects (2002,July 2008), The Cochrane Database of Systematic Reviews (2000,July 2008) and PubMed (1950,July 2008). Sleep quality was the outcome measure of interest. Selection criteria, Systematic reviews about the efficacy of one or more non-pharmacological interventions for insomnia, concerning both adult and elderly populations, were included. Reviews that included studies performed among populations suffering with severe neurological or cognitive impairments or with addictive disorders were excluded. Data analysis, Relevant data were extracted. The quality of the reviews found was appraised by using the Overview Quality Assessment Questionnaire. The evidence was appraised and divided into six classes. Results and conclusions, Sixteen reviews about 17 interventions were included. Six reviews were of adequate methodological quality. Of these, only one provided an effect size: a moderate effect was found for music-assisted relaxation. Weak evidence indicating a large effect was found for multicomponent cognitive behavioural therapy, progressive muscle relaxation, stimulus control and ,behavioural only'. Weak evidence indicating a moderate effect was found for paradoxical intention. Finally, weak evidence indicating a moderate to large effect was found for relaxation training. Because of the lack of sufficient methodological quality and the lack of calculated effect sizes, most of the included reviews were not suitable for drawing rigorous conclusions about the effect of non-pharmacological interventions on sleep quality in insomniacs. The non-pharmacological treatment of insomnia would benefit from renewed reviews based on a rigorous methodological approach. [source] Effectiveness of a lifestyle modification programme in weight maintenance in obese subjects after cessation of treatment with OrlistatJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 6 2007Jean Woo MD Abstract Objective, To examine the efficacy of a lifestyle modification programme in weight maintenance for obese subjects after cessation of treatment with Orlistat. Methods, Fifty-five subjects with and without diabetes mellitus were randomized to a lifestyle modification programme or to usual care at the end of 6 months' treatment with Orlistat. The intervention programme was nutritionist led, consisting of components of dietary management, physical activity, peer group support and discussion using techniques of self-monitoring, stimulus control and cognitive restructuring. Anthropometric indices, body composition, basal metabolic rate, blood pressure, fasting glucose, glycosylated haemoglobin, lipid profile, 24-hour urinary albumin excretion, dietary intake, physical activity level, and quality of life were assessed before and after the intervention period. Results, Subjects in the intervention group maintained their weight loss and favourable anthropometric, metabolic, dietary intake, physical activity and quality of life profiles, while most parameters deteriorated in the usual care group, being more marked in subjects with diabetes. The magnitude of weight gain was comparable to that lost during Orlistat treatment. Conclusion, A specially designed nutritionist-led lifestyle modification programme for obese subjects is effective in weight maintenance after treatment with Orlistat, in the absence of which the benefits of drug treatment were lost. The magnitude of the effect of lifestyle modification is comparable to that observed with Orlistat. [source] | ||||||||||