A pilot multiple-baseline study of a mobile cognitive behavioral therapy for the treatment of eating disorders in university students.

OBJECTIVE: Eating disorders (EDs) are serious psychiatric disorders associated with substantial morbidity and mortality that are prevalent among university students. Because many students do not receive treatment due to lack of access on university campuses, mobile-health (mHealth) adaptations of evidence-based treatments represent an opportunity to increase treatment accessibility and engagement. The purpose of this study was to test the initial efficacy of Building Healthy Eating and Self-Esteem Together for University Students (BEST-U), which is a 10-week mHealth self-guided cognitive-behavioral therapy (CBT-gsh) app that is paired with a brief 25-30-min weekly telehealth coaching, for reducing ED psychopathology in university students. METHOD: A non-concurrent multiple-baseline design (N = 8) was used to test the efficacy of BEST-U for reducing total ED psychopathology (primary outcome), ED-related behaviors and cognitions (secondary outcomes), and ED-related clinical impairment (secondary outcome). Data were examined using visual analysis and Tau-BC effect-size calculations. RESULTS: BEST-U significantly reduced total ED psychopathology and binge eating, excessive exercise, and restriction (effect sizes ranged from -0.39 to -0.92). Although body dissatisfaction decreased, it was not significant. There were insufficient numbers of participants engaging in purging to evaluate purging outcomes. Clinical impairment significantly reduced from pre-to-post-treatment. DISCUSSION: The current study provided initial evidence that BEST-U is a potentially efficacious treatment for reducing ED symptoms and ED-related clinical impairment. Although larger-scale randomized controlled trials are needed, BEST-U may represent an innovative, scalable tool that could reach greater numbers of underserved university students than traditional intervention-delivery models. PUBLIC SIGNIFICANCE: Using a single-case experimental design, we found evidence for the initial efficacy of a mobile guided-self-help cognitive-behavioral therapy program for university students with non-low weight binge-spectrum eating disorders. Participants reported significant reductions in ED symptoms and impairment after completion of the 10-week program. Guided self-help programs show promise for filling an important need for treatment among university students with an ED.

A single-case multiple baseline design for treating insomnia in eating disorders: The TIRED study.

OBJECTIVE: The purpose of this trial is to evaluate the novel use of an empirically supported treatment for sleep problems for people with residual insomnia disorder following ED treatment. METHOD: Participants (N = 6) will complete a single-case multiple baseline study using Brief Behavioral Treatment for Insomnia (Buysse et al., Archives of Internal Medicine, 171, 2011, 887-895; Troxel et al., Behavioral Sleep Medicine, 10, 2012, 266-279). Participants will complete pre- and post-treatment evaluations of insomnia severity, sleep efficiency, daytime fatigue, ED symptoms, depressive symptoms, and anxiety symptoms. Throughout treatment, participants will complete daily diaries of sleep indices (sleep latency, wake after sleep onset, total sleep time, and sleep efficiency). RESULTS: The primary outcome will be treatment effects on insomnia severity, measured by the Insomnia Severity Index. Secondary outcomes include sleep efficiency and daytime fatigue. Exploratory outcomes include ED-related impairment and symptoms, anxiety symptoms, and depression symptoms. We will provide subject-level graphs of sleep indices and ED symptoms throughout treatment. Additionally, treatment effects will be examined at one- and three-month follow-up. DISCUSSION: Although insomnia treatments have been evaluated in other psychiatric disorders, there has yet to be a study examining behavioral interventions for insomnia in EDs. Results of this study will inform the development and application of interventions for residual insomnia symptoms in this population.

The Effects of Condom Availability on College Women's Sexual Discounting.

College students commonly engage in risky sexual behaviors, such as casual sexual encounters and inconsistent condom use. Discounting paradigms that examine how individuals devalue rewards due to their delay or uncertainty have been used to improve our understanding of behavioral problems, including sexual risk. The current study assessed relations between college women's sexual partners discounting and risky sexual behavior. In this study, college women (N = 42) completed two sexual partners delay discounting tasks that assessed how choices among hypothetical sexual partners changed across a parametric range of delays in two conditions: condom availability and condom unavailability. Participants also completed two sexual partners probability discounting tasks that assessed partner choices across a parametric range of probabilities in condom availability and unavailability conditions. Additionally, participants reported risky sexual behavior on the Sexual Risk Survey (SRS). Participants discounted delayed partners more steeply in the condom availability condition, but those differences were significant only for those women with three or fewer lifetime sexual partners. There were no consistent differences in discounting rate across condom availability conditions for probability discounting. Sexual partners discounting measures correlated with risky sexual behaviors as measured by the SRS, but a greater number of significant relations were observed with the condoms-unavailable delay discounting task. These findings suggest the importance of examining the interaction of inconsistent condom use and multiple partners in examinations of sexual decision-making.

Being Kind to Your Future Self: Probability Discounting of Health Decision-Making.

INTRODUCTION: Nearly 50 % of patients with chronic medical illness exhibit poor treatment adherence. When making treatment decisions, these patients must balance the probability of current side effects against the probability of long-term benefits. This study examines if the behavioral economic construct of probability discounting can be used to explain treatment decisions in chronic disease. METHODS: Thirty-eight nonadherent and 39 adherent patients with multiple sclerosis (MS) completed a series of hypothetical treatment scenarios with varied risk and benefit probabilities. RESULTS: As described by a hyperbolic probability discounting model, all patients reported decreased medication initiation as the probability of treatment efficacy decreased and the probability of treatment side effects increased. When compared to adherent patients, nonadherent patients significantly devalued treatment efficacy and inflated treatment risk. DISCUSSION: The methods in this study can be used to identify optimal risk/benefit ratios for treatment development and inform the process by which patients make treatment decisions.

Automating Scoring of Delay Discounting for the 21- and 27-Item Monetary Choice Questionnaires.

Delay discounting describes the process wherein rewards lose value as a function of their delayed receipt; how quickly rewards lose value is termed the rate of delay discounting. Rates of delay discounting are robust predictors of much behavior of societal importance. One efficient approach to obtaining a human subject's rate of delay discounting is via the 21- and 27-item Monetary Choice Questionnaires, brief dichotomous choice tasks that assess preference between small immediate and larger delayed monetary outcomes. Unfortunately, the scoring procedures for the Monetary Choice Questionnaires are rather complex, which may serve as a barrier to their use. This report details a freely available Excel-based spreadsheet tool that automatically scores Monetary Choice Questionnaire response sets, using both traditional and contemporary/advanced approaches. An overview of the Monetary Choice Questionnaire and its scoring algorithm is provided. We conclude with general considerations for using the spreadsheet tool.

Robust relation between temporal discounting rates and body mass.

When given the choice between $100 today and $110 in 1 week, certain people are more likely to choose the immediate, yet smaller reward. The present study examined the relations between temporal discounting rate and body mass while accounting for important demographic variables, depressive symptoms, and behavioral inhibition and approach. After having their heights and weights measured, 100 healthy adults completed the Monetary Choice Questionnaire, the Beck Depression Inventory-II, and the Behavioral Inhibition Scale/Behavioral Approach Scale. Overweight and obese participants exhibited higher temporal discounting rates than underweight and healthy weight participants. Temporal discounting rates decreased as the magnitude of the delayed reward increased, even when other variables known to impact temporal discounting rate (i.e., age, education level, and annual household income) were used as covariates. A higher body mass was strongly related to choosing a more immediate monetary reward. Additional research is needed to determine whether consideration-of-future-consequences interventions, or perhaps cognitive control interventions, could be effective in obesity intervention or prevention programs.

Using crowdsourcing to compare temporal, social temporal, and probability discounting among obese and non-obese individuals.

Previous research comparing obese and non-obese samples on the delayed discounting procedure has produced mixed results. The aim of the current study was to clarify these discrepant findings by comparing a variety of temporal discounting measures in a large sample of internet users (n=1163) obtained from a crowdsourcing service, Amazon Mechanical Turk (AMT). Measures of temporal, social-temporal (a combination of standard and social temporal), and probability discounting were obtained. Significant differences were obtained on all discounting measures except probability discounting, but the obtained effect sizes were small. These data suggest that larger-N studies will be more likely to detect differences between obese and non-obese samples, and may afford the opportunity, in future studies, to decompose a large obese sample into different subgroups to examine the effect of other relevant measures, such as the reinforcing value of food, on discounting.

Reinforcer pathology, probabilistic choice, and medication adherence in patients with multiple sclerosis.

The reinforcer pathology model posits that core behavioral economic mechanisms, including delay discounting and behavioral economic demand, underlie adverse health decisions and related clinical disorders. Extensions beyond substance use disorder and obesity, however, are limited. Using a reinforcer pathology framework, this study evaluates medical adherence decisions in patients with multiple sclerosis. Participants completed behavioral economic measures, including delay discounting, probability discounting, and a medication purchase task. A medical decision-making task was also used to evaluate how sensitivity to mild side effect risk and efficacy contributed to the likelihood of taking a hypothetical disease-modifying therapy. Less steep delay discounting and more intense (greater) medication demand were independently associated with greater adherence to the medication decision-making procedure. More generally, the pattern of interrelations between the medication-specific and general behavioral economic metrics was consistent with and contributes to the reinforcer pathology model. Additional research is warranted to expand these models to different populations and health behaviors, including those of a positive health orientation (i.e., medication adherence).

A multiple-stimulus-without-replacement assessment for sexual partners: Test-retest stability.

The stability of stimulus preference assessment results is an important consideration when using the identified stimuli in treatments and/or additional experiments. Prior research has demonstrated that the preference hierarchies identified by the multiple stimulus without replacement (MSWO) preference assessment are generally stable over time. This stability has been demonstrated with tangible and edible items, yet the extent to which that stability can be expected for other types of stimuli remains unknown. The current study tested the 2-month stability of the MSWO preference assessment in the context of college students' preferred sexual partners. Adequate stability was shown in most cases, suggesting generality of the stability of preference across tasks, populations, and stimuli.

Differential Probability Discounting Rates of Gamblers in an American Indian Population.

Probability discounting, a subset of behavioral economic research, has a rich history of investigating choice behavior, especially as it pertains to risky decision making. Gambling involves both choice behavior and risky decision making which makes it an ideal behavior to investigate with discounting tasks. With proximity to a casino being one of the biggest risk factors, studies into the American Indian population have been a neglected population of study. Using outcome measures from a pre-scan probability discounting task, the current study equated the scan task to evaluate behavioral and neurobiological differences in gamblers vs. non-gamblers. Gamblers showed differences in behavioral tasks (lower discounting rates) but not in patterns of neural activation.

Applied behavioral economics and public health policies: Historical precedence and translational promise.

Behavioral economics is an approach to understanding behavior though integrating behavioral psychology and microeconomic principles. Advances in behavioral economics have resulted in quick-to-administer tasks to assess discounting (i.e., decrements in the subjective value of a commodity due to delayed or probabilistic receipt) and demand (i.e., effort exerted to defend baseline consumption of a commodity amidst increasing constraints)-these tasks are built upon decades of foundational work from the experimental analysis of behavior and exhibit adequate psychometric properties. We propose that the behavioral economic approach is particularly well suited, then, for experimentally evaluating potential public policy decisions, particularly during urgent times or crises. Using examples from our collaborations (e.g., cannabis legalization, happy hour alcohol pricing, severe weather alerts, COVID-19 vaccine marketing), we demonstrate how behavioral economic approaches have rendered novel insights to guide policy development and garnered widespread attention outside of academia. We conclude with implications on multidisciplinary work and other areas in need of behavioral economic investigations.

The behavioral economics and neuroeconomics of reinforcer pathologies: implications for etiology and treatment of addiction.

The current paper presents a novel approach to understanding and treating addiction. Drawing from work in behavioral economics and developments in the new field of neuroeconomics, we describe addiction as pathological patterns of responding resulting from the persistently high valuation of a reinforcer and/or an excessive preference for the immediate consumption of that reinforcer. We further suggest that, as indicated by the competing neurobehavioral decision systems theory, these patterns of pathological choice and consumption result from an imbalance between two distinct neurobehavioral systems. Specifically, pathological patterns of responding result from hyperactivity in the evolutionarily older impulsive system (which values immediate and low-cost reinforcers) and/or hypoactivity in the more recently evolved executive system (which is involved in the valuation of delayed reinforcers). This approach is then used to explain five phenomena that we believe any adequate theory of addiction must address.

Reconsidering delay discounting in bulimia nervosa.

Delay discounting measures one's preference for smaller-sooner versus larger-later reward and is a facet of impulsivity. Studying delay discounting in bulimia nervosa (BN) may enhance clinical understanding of BN, as BN is characterized by engagement in behaviors that provide immediate reward (i.e., binge eating, purging) at the expense of future well-being. Prior research suggests that individuals with BN prefer smaller amounts of money available sooner compared to psychiatrically healthy (HC) persons. Here, we aimed to replicate and extend previous work by studying delay discounting of both monetary and food reward in women with BN relative to HC women. We also compared delay discounting of monetary and food reward, and examined associations among delay discounting, trait impulsivity, and eating disorder symptom expression in women with BN. Participants were 20 women with sub- or full-threshold DSM-5 BN and 20 HC women who completed a diagnostic interview, paper-and-pencil measures of delay discounting of monetary and food commodities, and a measure of trait impulsivity. Contrary to previous work, we found that women with BN showed decreased delay discounting of monetary and food reward relative to HC women. Within-group analyses demonstrated that women with BN showed elevated delay discounting of food reward relative to monetary reward. Within women with BN, elevated delay discounting of food, but not money, was associated with elevated negative and positive urgency, two facets of trait impulsivity that relate to acting rashly when experiencing strong emotion. Results suggest that delay discounting may be more variable in BN than previously assumed.

Applied Quantitative Analysis of Behavior: What It Is, and Why We Care-Introduction to the Special Section.

Science evolves from prior approximations of its current form. Interest in changes in species over time was not a new concept when Darwin made his famous voyage to the Galapagos Islands; concern with speciation stretches back throughout the history of modern thought. Behavioral science also does and must evolve. Such change can be difficult, but it can also yield great dividends. The focus of the current special section is on a common mutation that appears to have emerged across these areas and the critical features that define an emerging research area-applied quantitative analysis of behavior (AQAB). In this introduction to the "Special Issue on Applications of Quantitative Methods," we will outline some of the common characteristics of research in this area, an exercise that will surely be outdated as the research area continues to progress. In doing so, we also describe how AQAB is relevant to theory, behavioral pharmacology, applied behavior analysis, and health behaviors. Finally, we provide a summary for the articles that appear in this special issue. The authors of these papers are all thinking outside the Skinner box, creating new tools and approaches, and testing them against relevant data. If we can keep up this evolution of methods and ideas, behavior analysis will regain its place at the head of the table!

Single- and cross-commodity discounting among adults who use alcohol and cannabis: Associations with tobacco use and clinical indicators.

BACKGROUND: Delay discounting assessments typically involve choices between an immediate outcome and a larger amount of the same outcome after a delay. Real-world choices, however, more often involve qualitatively different alternatives. The primary aim of this study was to examine single- and cross-commodity discounting of money, alcohol, and cannabis, along with clinical measures of alcohol and cannabis use among people who use both alcohol and cannabis, yet differ in tobacco cigarette smoking status (i.e., dual- versus tri-use). METHODS: An online crowdsourced sample (N = 318) of people who reported using alcohol and cannabis in the past week completed single- and cross-commodity discounting assessments across each combination of money, alcohol, and cannabis. We recruited a balanced number of people who did and did not also use tobacco cigarettes and examined associations between discounting, tobacco use, and clinical indicators. RESULTS: People who reported using tobacco cigarettes in addition to alcohol and cannabis tended to engage in significantly higher rates of harmful alcohol and cannabis use than those who reported using only alcohol and cannabis. Cross-commodity discounting was significantly associated with patterns of harmful alcohol and cannabis use while no associations emerged for single-commodity discounting. CONCLUSIONS: Cross-commodity discounting provides a nuanced account of intertemporal choice by incorporating relative commodity valuation and appears to characterize harmful alcohol and cannabis use more clearly than single-commodity arrangements. Further cross-commodity research is needed to better understand the interplay between temporal location and relative commodity value among people who use multiple substances.

On distinguishing progressively increasing response requirements for reinforcement.

Several different arrangements have been described for increasing the response requirements for reinforcement using the label progressive-ratio schedule. Under the original progressive-ratio schedule, the response requirement is increased after each reinforcer. Subsequently, arrangements have been used in which the number of required responses increases following multiple reinforcers at a single response requirement or between sessions. Following an assessment of the different types of contingencies that result from such progressive response requirements and the labels used to describe them, a set of descriptive labels is suggested for these different types of progressively increasing response requirements.

An experimental analysis of jackpot reinforcers.

Animal trainers and others often recommend the use of jackpot reinforcers, which are disproportionally large and come as a "surprise" to the animals. Because the actual behavioral effects of these jackpots remain uninvestigated, many basic questions about their use and even definition are unanswered. This series of experiments explored the definitions of jackpots using several different behavioral tests with both rats and pigeons. Because the original description of a jackpot resembled the reinstatement of previously reinforced and extinguished responding with response-independent deliveries of reinforcer, reinstatement effects of a jackpot, defined by its quality, were examined with rats in Experiment 1. In Experiment 2, response-potentiating effects of response-independent and -dependent deliveries of a jackpot, defined by its quantity, were assessed with pigeons when responding had nearly ceased. The response-potentiating effects of the frequency of jackpot-reinforcer delivery were investigated when responding of pigeons was maintained in single (Experiment 3) or concurrent (Experiment 4) schedules of reinforcement. Effects of jackpots on resistance to change were assessed with rats in Experiment 5. The effects of jackpots in each experiment were either absent or unsystematic across the subjects, casting doubt on their utility in animal training. Possible factors contributing to the negative results are discussed.

Persisting on the past: Cross-sectional and prospective associations between sunk cost propensity and cannabis use.

Prevalence of cannabis use in the United States continues to rise, and 30% of cannabis users eventually meet criteria for Cannabis Use Disorder (CUD). One response to this problem is to develop decision-making constructs that indicate vulnerability to CUD that might not be gleaned from diagnostic criteria. Unfortunately, there is limited evidence that decision-making constructs consistently relate to cannabis use. Interestingly, those who exhibit the sunk cost bias, an overgeneralized tendency to persist based on past investment, and those who use cannabis, both tend to focus on the past and perseverate more than their counterparts. Despite this overlap, no studies have assessed whether the sunk cost bias is positively associated with cannabis use. In 2 experiments with undergraduates, relations between cannabis use and the propensity to engage in the sunk cost bias were examined using negative binomial models. Experiment 1 (n = 46) evaluated the association between sunk cost bias propensity (using hypothetical costs and rewards) and frequency of cannabis use over the past 30 days. Greater sunk cost propensity was associated with more frequent cannabis use after controlling for demographics and alcohol use. In Experiment 2 (n = 103), more frequent cannabis use during a 6-week follow-up period was predicted by greater sunk cost propensity at baseline (using a real cost and reward-based task), independently and after controlling for mental health symptoms, alcohol use, and demographics. These findings provide preliminary evidence that a propensity to exhibit the sunk cost bias may be an important feature associated with cannabis use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Blunted satiety in fatty Zucker rats.

Levels of weight gain have hit an epidemic level with rates of overweight and obesity diagnoses topping all-time highs. Elevated body weight has been linked to increased rates of cardiac problems, blood pressure issues, and risk of developing type 2 diabetes. Leptin, a hormone produced by the body that is involved in energy balance by inhibiting hunger has been implicated as an underlying mechanism that differentially contributes to food-seeking motivation. Using a scientifically validated animal model of obesity, the fatty Zucker rat, which has mutated leptin receptor genes, leptin's role in behavioral motivation can be assessed. Animals were on a 2 -h food access restriction with one-hour access to rewards in session and one hour of free-feeding access. Pre-session and post-session food access differences were evaluated in looking at motivation for food rewards during satiation while responding on differing levels of fixed-ratio schedules. The results showed robust differential behavior from satiation, demonstrating a basis for a biological mechanism involving leptin sensitivity that could underlie obesity. Although further experimentation is needed, understanding leptin could help bridge the gap in our understanding of satiation and non-satiation.

Reinforcer pathology II: Reward magnitude, reward delay, and demand for alcohol collectively relate to college students' alcohol related problems.

The reinforcer pathologies model of addiction posits that two characteristic patterns of operant behavior characterize addiction. Specifically, individuals suffering from addiction have elevated levels of behavioral economic demand for their substances of abuse and have an elevated tendency to devalue delayed rewards (reflected in high delay discounting rates). Prior research has demonstrated that these behavioral economic markers are significant predictors of many of college students' alcohol-related problems. Delay discounting, however, is a complex behavioral performance likely undergirded by multiple behavioral processes. Emerging analytical approaches have isolated the role of participants' sensitivity to changes in reinforcer magnitude and changes in reinforcer delay. The current study uses these analytic approaches to compare participants' discounting of money versus alcohol, and to build regression models that leverage these new insights to predict a wider range of college students' alcohol related problems. Using these techniques, we were able to 1) demonstrate that individuals differed in their sensitivity to magnitudes of alcohol versus money, but not sensitivity to delays to those commodities and 2) that we could use our behavioral economic measures to predict a range of students' alcohol related problems.