Behavioral Approaches to the Treatment
of Autism and Severe Behavior Disorders
Wayne W. Fisher
University of Nebraska Medical Center’s
Munroe-Meyer Institute
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Autism and Childhood
Schizophrenia
Once thought to be a form of
schizophrenia
Differs from schizophrenia in terms
of symptoms, age of onset, family
history, etiology, and response to
treatment
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Definition of Autism
markedly abnormal or impaired
development in:
1. social interaction
2. Communication
and markedly restricted repertoire of
activities and interests.
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Definition of Autism
Definitions are cheap, but
explanations are dear, and we must be
careful not to confuse them.
» David Palmer, 2004
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Prevalence of Autism
Typically diagnosed within first three
years
Recent estimate indicate that the
prevalence of ASD is between 1 in 38 and
1 in 88
Four times more prevalent in boys than
girls
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Recurrence Risk for Siblings
If an older sibling has and autism
spectrum disorder, the risk for a
Younger brother is 1 in 4
Younger sister is 1 in 11
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NIH Research Dollars Devoted to Autism
When Compared with Other Serious
Childhood Conditions, Autism is Much
More Common, but Fewer Dollars Per
Case are Spent on Autism.
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Prevalence of Autism and Other Conditions
70
(Number of Cases per 10,000 Children)
60
50
40
30
20
10
0
Autism
Juvenile DiabetesMuscular Dystrophy Leukemia
Cystic Fibrosis
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NIH Research Dollars for Autism and Other Conditions
(Number of Dollars per Case)
$140,000
$120,000
$100,000
$80,000
$60,000
$40,000
$20,000
$Autism
Juvenile Diabetes
Muscular Dystrophy
Leukemia
Cystic Fibrosis
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Unfortunately, you have what we call “no insurance.”
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Demographics of Autism
Affects all racial, ethnic, and national groups
Family income, lifestyle, and educational
levels do not affect the chance of autism's
occurrence
Diagnosis of autism is growing at a rate of 1017 percent per year (U.S. Department of
Education, 2002)
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Assessment and Diagnosis of
Autism
No medical tests for diagnosing autism
Accurate diagnosis is based on observation
of the individual's communication, behavior,
and developmental levels.

Autism Diagnostic Interview-R (ADI-R)

Autism Diagnostic Observation Schedule (ADOS)

Home and/or school observation

Video analysis of behavioral observation
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Social Behavior Generally Requires
Little or No Explicit Training
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Assessment and Acquired Autism
Autism is most often diagnosed between 2
and 5 years of age.
Thus, it is natural for parents to look for
environmental events occurring shortly before
this time that may have caused the autism,
such as childhood vaccines.
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MMR Vaccines and Autism
10 of the original 13 authors of the
investigation that started the controversy
have retracted the study’s interpretation,
as has the journal, The Lancet
Prevalence rates of autism are
equivalent in children who have and have
not been vaccinated.
Increases in the prevalence of autism
did not abate when thimerosal was
removed from vaccines.
Regression in autism is no more likely in
the months after the MMR vaccine than in
the months before the vaccine.
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Identifying the Genetic Bases of
Autism Spectrum Disorders
Etiologic Workups Identify Specific Genetic
Causes for Autism in About 20% of Cases.
At the Munroe Meyer Institute, Shaefer and
Colleagues (2006) have developed a 3-Tiered
Approach that Identifies Genetic Causes in
40% of Cases.
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Associated Disorders
Autism
ASD
Mental Retardation
50% 15%
Seizure Disorder
35% 10%
 Self-Injury, Aggression
50%
Tourette Disorder
Bipolar Disorder
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Associated Etiologic Diagnoses
Fragile-X syndrome
Tuberous Sclerosis
Williams syndrome
Landau-Kleffner syndrome
Congenital Rubella
Smith-Magenis syndrome
Neurofibromatosis
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Genetics and Twin Studies
Autism runs in families
Heritability for autism is about 90%
Monozygotic twin concordance, 60%-100%
Dizygotic twin concordance, 10%
Associated with abnormalities on
chromosomes 7q, 2q, and 15q
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Applied Behavior Analysis (ABA)
What is ABA?
How is it different from other
approaches?
How is it Done?
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How Effective is ABA for Autism?
About 50% of Children with Autism and
no More than Mild Mental Retardation who
Receive Early Intervention with ABA Attain
Normal IQs and are Educated in Regular
Classrooms with Minimal Assistance.
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Outcomes of ABA for Autism
35
Increases in IQ Scores
30
25
20
15
r = .79
p < .02
10
5
0
0
5
10
15
20
25
30
Hours per Week of Treatment
35
40
45
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Cost-Benefit Analysis of Early,
Intensive ABA for Autism
Average Lifetime Cost for a Person
with Autism is over $4 million
Average cost of Early, Intensive
ABA is $150,000 over about 3 years
Average Lifetime Savings from
ABA Treatment is Between $1.6 and
$2.7 million
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Cost-Benefit Analysis of ABA treatment
for Severe Behavior Disorders
Children with Autism and Severe
Destructive Behavior Cost $8 million
over a lifetime.
Keeping just one child out of chronic
care pays for treatment of hundreds
more.
Our treatment approach has over an
80% success rate.
Case Example
4000
$4,050,000
(Costs since 1986)
3500
Dollars in Thousands
3000
2500
2000
1500
1000
500
$85,924
0
Inpatient and Outpatient
Costs
Residential Costs
Over 25 Years
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Autism and Problem Behavior
98% of children with autism have one or more of
the following problems:
1.
Feeding problems
2.
Sleeping problems
3.
Tantrums
4.
Self-injurious behavior
5.
Aggression
Dominick et al. (2007)
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Variables Related to Problem
Behavior in Autism
Lower IQ scores were associated more problem
behaviors
Lower expressive language scores were
associated with more problem behaviors
Increased social deficits were associated with
more problem behaviors
Dominick et al. (2007)
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Functional Analysis and
Treatment of Aberrant
Behavior
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Structural vs. Functional Diagnosis
Structural Approach
1.
How often a particular set of symptoms
or responses cluster or covary.
Functional Approach
1.
Whether and which environmental
variables influence the response.
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Functional Analysis
Identifies the environmental contexts
in which aberrant behavior is likely
and unlikely.
Identifies the consequences that
reinforce and maintain the behavior.
Used to prescribe effective
treatments.
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Common Functions of SIB
Social Positive Reinforcement
(Attention, Tangible items)
Social Negative Reinforcement
(Escape)
Automatic Reinforcement (e.g.,
Sensory Stimulation)
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Essential Features of Functional
Analysis Conditions
Unique discriminative stimuli that
signal the available of a specific
reinforcer
Establishing operation (EO) that
increases motivation for the specific
reinforcer
1.
An EO is an environmental condition that
momentarily increases the effectiveness of a
reinforcer and that evokes responses that have
produced that reinforcer in the past.
Contingency between the target behavior
and the specific reinforcer
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Identifying the Essential Features of
Functional Analysis Conditions
See if you can identify the
discriminative stimulus, the
establishing operation, and the
reinforcement contingency in each of
the following functional analysis
conditions.
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Attention Condition
Adult is busy reading. Child is expected to
play quietly with toys.
Adult attention shifts to child following SIB
(e.g., “Please don’t hit yourself”).
Determines whether adult attention
functions as reinforcement for SIB.
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Essential Features of the Attention
Condition
Discriminative Stimulus: Adult is seated in
a chair reading a book.
EO: Attention is unavailable.
Contingency: SIB produces attention.
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Tangible Condition
Adult takes preferred toys or leisure
materials from the child and returns
them following SIB.
Determines whether access to
preferred items functions as
reinforcement for SIB.
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Essential Features of the Tangible Condition
Discriminative Stimulus: Adult takes
and holds the preferred tangible item
at the start of the session.
EO: Tangible item is unavailable in
the absence of SIB.
Contingency: SIB produces the
tangible item.
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Demand Condition
Child is prompted to complete nonpreferred tasks by an adult.
The task is removed and the child is
given a short break following SIB.
Determines whether termination of
non-preferred activities functions as
reinforcement for SIB.
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Essential Features of the Demand
Condition
Discriminative Stimulus: Instructional
materials and demands are presented.
EO: Nonpreferred demands are presented.
Contingency: SIB results in temporary
removal of the demands.
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Alone Condition
Child is placed in a room alone
without toys or materials.
Indirectly assesses whether SIB may
be maintained by automatic
reinforcement (e.g., sensory
stimulation).
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Essential Features of the Alone Condition
Discriminative Stimulus: Absence of
another individual or materials.
EO: Alternative sources of stimulation are
unavailable.
Contingency: SIB produces selfstimulation.
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Toy Play Condition
Child and adult play together with
preferred toys or leisure items.
Adult delivers praise about once
every 30 seconds for the absence of
SIB.
Designed to be an analogue of an
“enriched environment”, which serves
as a control condition.
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Essential Features of the
Toy Play Condition
Discriminative Stimulus: Adult and
toys are near the individual.
EO (or AO): Attention and tangible
items (toys) are freely available and no
demands are presented.
Contingency: SIB produces no
consequence.
Per Minute
Aggressive Responses
3
Attention
2
Ignore
1
Tangible
Demand
Play
0
1
3
5
7
9
11
13
15
17
19
21
23
Sessions
25
27
29
31
33
35
37
39
8
Baseline
FCT +
Baseline
Extinction
FCT +
Extinction
Destructive
Behavior
Response per Minute
6
4
Kirk
Communication
2
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Session
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Functional Analysis of Covert
Drug Ingestion
Three Operant Hypotheses
Generated After Caregiver Interview
and Chart Review
1. Attention/Excitement From Medical
Procedures
2. Attention From Mother
3. Escape From Work Activities
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Functional Analysis of Covert Drug
Ingestion (cont.)
Sessions Conducted in a Classroom
and an Adjoining Medication Room
Baited With Placebos in a Pillbox.
Patient was Left Unsupervised in the
Classroom With a Schoolwork
Assignment.
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Functional Analysis of Covert Drug
Ingestion (cont.)
In the Pillbox Were Four Pill Bottles
Containing Placebos.
Each Pill Bottle had a Uniquely
Colored Label.
Consuming Pills From Each Pill
Bottle Produced a Specific
Consequence.
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Functional Analysis of Covert Drug
Ingestion (cont.)
Red = Medical Attention
Orange = Attention From Mother
Blue = Rest Period (Escape)
Yellow = Control (Ignore)
PILLS INGESTED PER MINUTE
20
Escape From Work
15
Parent Attention
10
5
Control
Medical Attention
LYLE
0
1
5
10
15
SESSIONS
FUNCTIONAL ANALYSIS
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Treatment of Escape-Maintained
Drug Ingestion
Lyle Earned Preferred, Nonwork
Activities for Completing Scheduled
Activities and Turning in Pills.
He was Required to Complete His
Least Preferred Work Activity (Shoe
Polishing) if He Ingested Pills.
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PILLS INGESTED PER MINUTE
20
Baseline
Treatment
Baseline
Treatment
15
10
5
LYLE
0
10
20
30
40
50
60
70
80
SESSIONS
TREATMENT ANALYSIS
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Treatment Extension of EscapeMaintained Drug Ingestion
Lyle was Gradually Exposed to
Different Settings where He was
Observed and Supervised Less.
Detection Methods Were Faded From
Direct Observation to Pill Bottles With
Residue and Then to Weekly Tox
Screens.
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Functional Communication
Training (FCT)
Functional communication training (FCT) is a
treatment commonly prescribed when a functional
analysis has shown that an individual’s problem
behavior is maintained by social consequences
(e.g., Carr & Durand, 1985; Fisher et al., 1993;
Horner, Day, Sprague, O’Brien, & Heathfield, 1991;
Lalli, Casey, & Kates, 1995; Wacker et al., 1990).
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Functional Communication
Training (FCT)
With FCT, the individual is taught a
communicative response that produces access to
the reinforcer responsible for maintenance of the
problem.
For example, an individual whose problem
behavior is maintained by escape from tasks might
be taught to request a break by signing ‘‘finished’’
(e.g., Hagopian, Fisher, Sullivan, Acquisto, &
LeBlanc, 1998).
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Unique Features of FCT
FCT is a DRA procedure that:
1.
specifies its reinforcer (i.e., a mand specifying the
reinforcer that previously maintained problem behavior),
2.
requires minimal response effort,
3.
is initially reinforced on a dense schedule (e.g., FR 1),
4.
can recruit reinforcement across environmental
contexts.
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Unique Features of FCT
Because of the ease and consistency with which
reinforcement can be obtained during FCT, some
authors have suggested that the client ‘‘controls’’ the
delivery of reinforcement (e.g., Carr & Durand, 1985).
In addition, Carr and Durand suggested that
“control over reinforcement,’’ contributed to the
effectiveness of FCT.
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Unique Features of FCT
Two investigations found that noncontingent
reinforcement (NCR), which does not allow the client
to control the schedule of reinforcement, and FCT,
which does, produced equivalent reductions in
problem behavior (Hanley, Piazza, Fisher, Contrucci,
& Maglieri, 1997; Kahng et al., 1997).
Nevertheless, we found that participants preferred
FCT over NCR when given a choice (Hanley et al.,
1997).
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Unique Features of FCT
FCT may promote generalization and maintenance
because the communication response may prompt
both trained and untrained caregivers to deliver
differential reinforcement appropriately (e.g., Durand
& Carr, 1991).
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Limitations of FCT
 Teaching the FCT response may evoke problem
behavior (particularly if it is maintained by escape).
Individuals may display the FCT response at
exceedingly high rates (e.g., requesting a break from
every school task).
Individuals may request reinforcement at times
when it is impossible or inconvenient to deliver (e.g.,
caregiver tending to an infant sibling).
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Selecting the Functional
Communication Response (FCR)
The FCR should be simple.
The FCR should produce the reinforcer
identified during the functional analysis.
 The FCR should quickly remove the
establishing operation for problem behavior.
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Training the Communication Response
The communication response matches
the function of the child’s problem
behavior.
1. Demand -> “Break please.”
2. Attention -> “Play with me, please.”
3. Tangible -> “Toy please.”
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Training the Communication Response
Children who do not speak are often
taught to use a picture-exchange
communication response.
1. Attention -> Child hands over a picture of the
adult and child playing together.
2. Demand -> Child hands over a picture of the
child leaving a work table.
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Function-Based Extinction
EXT (Att): Attention no longer follows the
target behavior
EXT (Tang): Tangible item is longer
presented following the target behavior
EXT (Esc): Demands continue following the
target behavior
EXT (Auto): The sensory consequences of
the target response are eliminated or the
response is prevented.
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Stimulus Control Refinements of FCT
Controlling the establishing operation for
problem behavior is particularly important during
the early stages of treatment.
Bringing the functional communication response
under tight discriminative control is particularly
important for increasing the practicality and
generality of FCT.
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Study 1: Does strict control of exposure to the
establishing operation (EO) for problem
behavior facilitate the effectiveness of FCT?
We compared FCT using a picture exchange (or card
touch) as the FCR with a vocal FCR.
The picture exchange version of FCT (FCT-card)
allows strict control of the EO, because the therapist
can immediately guide the FCR and deliver the
reinforcer, which removes the EO.
The vocal version of FCT (FCT-vocal) does not allow
strict control of the EO, because one cannot guide a
vocal response.
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Study 1: Procedures
Following baseline, the two FCT treatments (FCT-card
and FCT-vocal) were both introduced using a
progressive time-delay procedure to teach each FCR.
The two treatments were compared using a
multielement phase.
Following a return to baseline, the more effective
treatment was re-introduced in the final phase.
t = 3.0; p = .01
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Study 1: Conclusions
The FCT-card card condition allowed better control of
the EO for problem behavior.
The FCT-card condition produced more rapid
reductions in problem behavior.
The FCT-vocal condition was associated with an
extinction burst for one participant, which was not
observed in the FCT-card condition.
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Controlling the EO While Training the
Communication Response
When FCT is initiated, the communication
response should always produce the
reinforcer.
If the child cannot do the response
independently, we help them and then
immediately deliver the reinforcer.
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Stimulus Control Refinements of FCT
Controlling the establishing operation for
problem behavior is particularly important during
the early stages of treatment.
Bringing the functional communication response
under tight discriminative control is particularly
important for increasing the practicality and
generality of FCT.
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Schedule Thinning During Functional
Communication Training
Signaled and unsignaled delayed
reinforcement (Vollmer et al., 1999)
 Activities or alternative reinforcers during the
reinforcement delays (Fisher et al., 1998; 2000)
 Multiple schedules with reinforcement and
extinction components (Betz et al., 2913; Fisher
et al., 1998; Hanley et al., 2001)
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Typical Multiple-Schedule Training
During FCT
Quasi-random alternation between and FR-1
schedule and EXT for communication
Each component correlated with a specific
signal
Initially, the duration of the reinforcement
component is 3 to 4 times longer than the
EXT component
Gradually, the EXT component is
lengthened relative to the SR+ component
= FR1
FADING STEPS
1
45 s
2
60 s
3
60 s
4
5
6
60 s
60 s
60 s
7
60 s
8
60 s
= Extinction
15 s
30 s
Decreases reinforcer
deliveries by about 75%
45 s
60 s
90 s
120 s
180 s
240 s
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Purpose
 To identify the necessary and sufficient components
for the reinforcement schedule thinning
1. Study 2: Evaluated the effects of contingency-correlated
stimuli during FCT
2. Study 3: Evaluated the necessity of systematic and gradual
fading steps during schedule thinning under multiple
schedule components
3. Study 4: Evaluated the extent to which contingencycorrelated stimuli facilitated generalization across therapists
and environments
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Functional Analysis and FCT Treatment
Evaluations
 Prior to Studies 2, 3, and 4, we conducted functional
analyses to show that problem behavior was
reinforced by social positive reinforcement for all
participants.
 We also conducted treatment evaluations using an
ABAB design to show that FCT was an effective
treatment.
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Study 2: Are contingency-correlated stimuli
necessary?
 Compared rates of FCR and problem behavior
under equivalent mixed and multiple schedules
using an ABAB design
1. Mixed FR-1:60 s / EXT:60 s
2. Multiple FR-1:60 s / EXT:60 s
Data on problem behavior is not shown because
it remained at near-zero levels throughout this
study.
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Mixed vs. Multiple Assessment
General Procedures
1.
Sessions = 10 min
2.
Contingency specifying stimuli in both conditions
3.
FR1 = 60 s
4.
Extinction = 60 s
5.
All sessions started with reinforcement interval
6.
All problem behavior was on extinction
Multiple
4
Mixed
Multiple
Mixed
3
MANDS PER MINUTE
CASEY
2
FR1:
60 s
EXT:
60 s
1
0
0
5
10
15
20
SESSIONS
-1
25
30
35
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Study 3: Is schedule fading necessary?
Compared rates of alternative and problem behavior
when schedules were switched from rich to lean
without schedule fading in a multiple baseline design
Mult FR-1:60 s / EXT:60 s to Mult FR-1:60 s / EXT:240 s
Mixed FR-1:60 s / EXT:60 s to Mult FR-1:60 s / EXT:240 s
Data on problem behavior is not shown because it
remained at near-zero levels throughout this study.
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Study 4: Do contingency-correlated stimuli
facilitate generalization across therapists and
settings?
Compared rates of alternative and problem behavior
when a multiple schedule was introduce across
therapists or settings in a multiple baseline design
Mixed FR-1:60 s / EXT:60 s to Mult FR-1:60 s / EXT:60 s
Mult FR-1:60 s / EXT:60 s to Mult FR-1:60 s / EXT:300 s
Data on problem behavior is not shown because it
remained at near-zero levels throughout this study.
University of Nebraska Medical Center
University of Nebraska Medical Center
University of Nebraska Medical Center
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Conclusions
 Study 2 showed that inclusion of contingencycorrelated stimuli was a necessary component of
FCT schedule thinning.
 Study 3 showed that inclusion of contingency-
correlated stimuli was sufficient to maintain
appropriate responding without gradually fading the
schedule density during FCT schedule thinning.
 Study 4 showed that contingency-correlated
stimuli also facilitated generalization of FCT effects
across therapists and settings.
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Study 5: How effective is Mult-FCT across a large
cohort of patients with problem behavior?
Hagopian et al. (1998) found that FCT with EXT (FCTE)
failed in 14 of 25 cases during schedule thinning.
212
They also found that FCT with
punishment (FCTP)
reduced destructive behavior by 90% or more in all
cases, even following reinforcer-schedule thinning.
In the current study, we summarized the results of 14
applications of Mult-FCT implemented with 12 cases and
compared the results with those of Hagopian et al.
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Amount of Reinforcer-Schedule Thinning
The reinforcement schedule was thinned to the
values listed below by rapidly lengthening the
duration of the EXT component once the
participant showed discriminated responding in
Mult-FCT.

60/240: Seven applications (80% reduction in Sr+)

60/540: Six applications (90% reduction in Sr+)

FR1/400: One application (> 90% reduction in Sr+)
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Calculating Percentage Reduction
in Problem Behavior
Percentage reductions in problem behavior were
calculated using the following formula (same as in
Hagopian et al. [1998]):
Mean rate during last 5 sessions
1–
Mean rate during baseline
Percent Reduction in Problem Behavior
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110
Hagopian et al. (1998)
Current
Data Set
100
90
80
70
60
50
40
30
20
10
0
n = 11
n = 17
n = 14
applications
applications
applications
FCTE +
Fading
FCTP +
Fading
Mult-FCT +
Fading
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Future Grants and Research on:
Consequence Control Refinements of FCT
Using behavioral momentum theory (BMT) and
accompanying equations to prevent relapse and
resurgence of problem behavior.
BMT makes predictions that are at odds with
current clinical “best practices”.
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Limitations of FCT (cont.)
 When a parent is busy and fails to deliver
reinforcement for the child’s FCT response, the child
is likely to revert to problem behavior, a phenomena
called “resurgence”.
Recent research has shown that resurgence of
problem behavior is quite common, and problem
behavior often occurs at pre-treatment levels when
the FCT response goes unreinforced (Mace et al.,
2010; Volkert et al., 2009).
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Mace et al., (2010)
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Volkert et al., (2009)
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Behavioral Momentum Theory
Behavioral momentum theory is a quantitative
theory of behavior that employs a comparative
metaphor based on the classical mechanics of the
momentum of physical objects.
Behavioral momentum theory is relevant to FCT
because it provides quantitative models and
predictions about the persistence and resurgence
of problem behavior when the FCT produces
reinforcement and when it does not.
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The Momentum Metaphor
In classical mechanics, the momentum of an
object is a joint function of its mass and velocity.
Momentum of a moving object =
mass x velocity
Momentum of a response =
rate of reinforcement x response rate
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Equation 7 Predicts the Effects of Adding and
Removing Reinforcement for the FCT
Response
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Common Practice Guidelines for FCT
 Decreases may occur more rapidly during
treatment if problem behavior is reinforced on a CRF
schedule during baseline (Fisher & Bouxsein, 2011).
“… we strongly recommend that the
communicative response be reinforced on a CRF
schedule initially (Tiger, Hanley, & Bruzek, 2008).
Clinical guidelines on “dosage” levels of FCT are
not available (i.e., How many sessions of FCT are
needed before parent training and discharge?).
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Specific Recommendations of BMT
The magnitude of resurgence predicted by
Equation 7 is minimized by:
1.
maximizing the value of t conducting many FCT
sessions before exposure to an EXT challenge;
2.
maximizing the value of d by correlating periods of
reinforcement and EXT of the FCR with discriminative
stimuli;
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Specific Recommendations of BMT
The magnitude of resurgence predicted by
Equation 7 is minimized by:
3.
minimizing the value of r by delivering the lowest
possible rate of reinforcement for destructive
behavior during baseline; and
4.
minimizing the value of Ra by delivering the lowest
possible rate of reinforcement of the FCR during FCT.
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300
Destructive Responses per Hour
Baseline
Extinction Challenge
FCT
(VI 30)
(VI 20)
250
200
150
c = 1, d = .001, p = .05
Long Exposure
(Room 1;
Therapist = Purple)
100
Short Exposure
(Room 2;
Therapist = Yellow)
50
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Session
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250
Destructive Responses per Hour
Baseline
Extinction Challenge
FCT
(VI 36 s)
200
150
c = 1, d = .001, p = .05
100
VI 20 s
(Room 1;
Therapist = Red)
VI 120 s*
(Room 2;
Therapist = Blue)
50
0
1
2
3
4
5
6
7
determined based on a
progressive-interval assessment and may be different from a VI 120 s.
*This lean schedule will be individually
8
9
10
Session
11
12
13
14
15
16
17
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250
Destructive Responses per Hour
Baseline (VI 36 s)
PI
FCT
Extinction Challenge
200
VI 20 s (Room 1;
150
Therapist = Green)
c = 1, d = .001, p = .05
100
VI 180 s
(Room 2;
Therapist = Blue)
50
0
1
2
3
4
5
6
7
8
9
10
Session
11
12
13
14
15
16
17
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250
Destructive Responses per Hour
Baseline
EXT Challenge
FCT
200
150
c = 1, d = .001, p = .05
Long Exposure of
Alt VI 120 s*
100
(Room 1;
Therapist = Red)
VI 20 s
(Room 2;
Ther = Blue)
Short Exposrue of
Alt VI 20 s
50
(Room 2;
Therapist = Blue)
VI 120 s*
(Room 1;
Ther = Red)
0
1
*Lean
2
3
4
5
6
7
8
9
10
11
12
schedules to be individually determined based on PI
assessments; they may be leaner or denser than VI 120 s.
13
14
15
16
17
18
Sessions
19
20
21
22
23
24
25
26
27
28
29
30
31
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Concluding Comments
 Mathematical models like behavioral momentum
theory provide a method for developing new and
interesting clinical research questions that have the
potential to greatly improve treatments like FCT.
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University
of Nebraska
Medical Center
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Munroe-Meyer
Institute