Protocolized Intervention for Children and Adolescents With Phagophobia.

We aimed to prospectively evaluate the effectiveness of a protocolized shaping intervention in children with phagophobia, which occurs when an aversive oral experience causes fear of swallowing and can result in restricted oral intake and weight loss. Twenty-one children (12 males) diagnosed with phagophobia (mean age 8.5 years) underwent initial medical workup and a pediatric psychologist driven shaping protocol. The outpatient protocol involved graduated food exposure with anxiety reduction strategies to eliminate anxiety and expand participants' diet. The participants completed an average of 6 treatment sessions. Post-treatment, there was a significant increase in weight, total number of foods consumed, and number of foods consumed across food groups and texture. Additionally, self-reported subjective units of distress were low for all participants throughout treatment. We conclude that after appropriate medical workup behavioral treatment is safe and efficacious in children with phagophobia and returns children to premorbid functioning and diet.

Group Treatment of Fecal Incontinence: A Description of an Interdisciplinary Intervention.

INTRODUCTION: Approximately 5% of children in the United States have chronic fecal incontinence. Unfortunately, standard medical management of fecal incontinence fails in 20% to 60% of cases. A combined medical-behavioral model is often recommended in these cases. The purpose of this pilot study was to describe an interdisciplinary group-based treatment for fecal incontinence in school-aged children, and to present a description of changes in treatment adherence rates that affect clinical effectiveness. METHOD: Poop group employed a developmentally appropriate model of care in which caregivers and children participated in separate but simultaneously held therapy groups. This interdisciplinary 6-week protocol is designed to increase appropriate stooling, decrease soiling events, and increase medication adherence pre- to post-treatment. Group sessions focus on the GI system, medication, toilet sitting posture, hydration, fiber, and behavior contracts. In addition, participant families consult with an Advanced Nurse Practitioner privately at each session discussing symptoms and making medication modifications as needed. RESULTS: Nineteen families completed the 6-week protocol. Appropriate stool frequency was improved (P ≤ 0.01), and soiling was reduced (P ≤ 0.00). Medication adherence was also improved (P ≤ 0.04). Treatment results were maintained at 1-month follow-up. DISCUSSION: A developmentally targeted intervention and interdisciplinary focus of treatment likely account for treatment successes. CONCLUSION: Poop group may be an effective interdisciplinary treatment option for families of children who fail traditional outpatient treatment.

Delay discounting of potentially real and hypothetical rewards: II. Between- and within-subject comparisons.

Prior studies comparing discounting of delayed hypothetical or potentially real rewards have reported no differences, but they used within-subjects designs. This raises the possibility that participants remembered their choices in one condition and repeated them in the other. In Experiment 1, between-subjects comparisons were made with an adjusting-amount procedure. No significant effect of reward type on delay discounting was detected. Experiment 2 increased the proportion of real rewards and made between- and within-subject comparisons. These comparisons also failed to reveal a significant effect of reward type. Although these findings are consistent with prior findings, caution is urged because choices involving hypothetical rewards have yet to be compared with choices involving real rewards (i.e., the consequences of every choice are obtained) in an experiment using forced-choice trials and steady-state methodology.

The relationship between experiential avoidance and the severity of trichotillomania in a nonreferred sample.

In this study 436 adults, who reported being diagnosed with trichotillomania (TTM), completed an anonymous survey examining the relationship between experiential avoidance (i.e., escape from or avoidance of unwanted thoughts or emotions) and TTM severity. Results showed a significant positive correlation between measures of experiential avoidance and TTM severity, indicating that more experientially avoidant individuals tended to exhibit more severe TTM. Subsequent analyses found that persons who scored higher on a measure of experiential avoidance reported more frequent and intense urges to pull, were less able to control their urges, and experienced more pulling-related distress than persons who were not experientially avoidant. Conversely, results also showed that individuals who were more experientially avoidant were no more likely to actually pull and were no less successful in actually stopping themselves from pulling than non-avoidant individuals. The results of this study suggest that experiential avoidance may be an important issue in understanding and possibly treating some persons with TTM.

Delay discounting of real and hypothetical rewards.

The degree to which real and hypothetical rewards were discounted across delays ranging from 6 hr to 1 year was explored in a within-subjects design. An adjusting-amounts procedure was used to estimate the subjective value of real and hypothetical rewards at each delay. A hyperbolic discounting function provided a significantly better fit to individual participants' preferences than did an exponential function. No significant effect of reward type on degree of hyperbolic discounting or area under the discounting curves was detected. These findings offer some support for the validity of using hypothetical rewards to estimate discounting rates in substance-abusing and other populations, but caution is suggested because this support is gleaned from a failure to detect an effect of reward type.