Cognitive behavioral treatment to improve adherence to hemodialysis fluid restrictions: a case report.

This case report describes outpatient psychological treatment targeting adherence to fluid restrictions in a hemodialysis patient. The consequences of nonadherence to fluid restrictions in hemodialysis patients range from minor discomfort to increased hospitalizations and mortality rates. In addition, when patients chronically fail to adhere, they may no longer be candidates for kidney transplant. The interventions focused on polydipsia, characterized by excessive fluid intake. The methods involved 11-sessions of individual psychotherapy incorporating strategies including increasing awareness, decreasing motivation, increasing effort, engaging in competing events, conducting thought stopping, breaking repetitive routines, eliciting social support, and receiving reinforcement. Results demonstrated that the patient successfully restricted his fluid intake at or below recommended levels 83% of days after fading of treatment began. This case report demonstrates the success of cognitive behavioral treatment strategies with a nonpsychiatric hemodialysis patient.

Replacing overt verbal and gestural prompts with unobtrusive covert tactile prompting for students with autism.

Verbal responses, gestures, and other physical stimuli are often used to prompt children to pay attention to their teacher, participate in group responding, and engage in independent activities in the classroom. Prompts can be intrusive and draw attention to the problem, however. In the present study, unobtrusive vibrating pagers were used to discreetly alert children to attend directly to the teacher or the ongoing activity, thus reducing the number of disruptions the children created in their classrooms. The children were then able to learn more effectively and with less interference to others in the vicinity. Specifically, 5 male children, between 4 and 7 years old, who attended a regular education preschool or regular education first-grade classroom, participated. An alternating baseline and treatment conditions design was used, in which periods of overt traditional prompting were alternated with periods of covert tactile and overt traditional prompting. The data showed that covert tactile prompting was successful in reducing the amount of overt traditional prompting that was needed for attention to a teacher, group responding, and engagement in independent activities.