Study Objective: Examination, through self-monitoring with GPS and real-time monitoring using social media, of effects of an intervention in everyday situations that was intended to increase the time going out and the social interactions of a woman who was socially withdrawn and who had been diagnosed with schizophrenia. Design: ABB’+follow-up. Settings: Outpatient setting at a private counseling office and the participant’s daily life situations. Participant: A woman in her early 20s who complained about hallucinations, was socially withdrawn, and had been diagnosed with schizophrenia. Intervention: Exposure to feared situations. Measures: Time spent going out alone, frequency of going out, and repertoires of going out. Results: The participant’s time, frequency, and repertoires of going out increased. The participant was able to get a part-time job. Conclusion: Reliable self-monitoring by GPS and real-time monitoring through social media on her mobile phone verified the changes in the participant’s behavior during and after the intervention.

Study Objective: Examination of effects of an intervention using response prevention, combined with positive reinforcement for appropriate behavior and a monetary fine for inappropriate behavior, for a boy with comorbid autism spectrum and obsessive-compulsive disorders who had increased frequent trips to the toilet after bedtime and increased urine leakage in the morning. Design: AB design, followed by a probe period. Setting: The participant’s home. Participant: A boy (age: 10 years 10 months) with comorbid autism spectrum and obsessive-compulsive disorders. Intervention: In order to implement response prevention, environmental adjustments were made so that his bedroom door could be locked, with the result that he could not leave his room to go to the toilet after bedtime. In addition, the boy was given 50 yen when there was no urine leakage in the morning, and fined 500 yen (“repair fine”) if he opened his bedroom door while it was locked. Measures: Trying to go to the toilet after bedtime and the presence of urine leakage in the morning. Results: During the intervention, all attempts to go to the toilet after bedtime were successfully blocked. Urine leakage also ceased to occur. In the probe period, the door was not locked after the boy went to bed. Neither the target behavior nor urine leakage occurred at all. Conclusion: For this child with comorbid autism spectrum and obsessive-compulsive disorders, the effects of response prevention combined with a monetary reward and fine were immediate.

Study Objective: The purpose of the present study was to use behavioral measures to evaluate effects of exposure and ritual prevention (ERP) in a treatment of a patient who presented compulsive checking behavior and was diagnosed as having an obsessive-compulsive disorder (OCD). Design: AB design. Settings: A consulting room at a psychiatric clinic, a convenience store, and a train station near the clinic. Participant: A woman in her late twenties with a diagnosis of obsessive-compulsive disorder. Intervention: Exposure to cause anxiety about lost items by taking a piece of paper from a bag and throwing it in a trash can, and ritual prevention for compulsive checking. Measure: Number of discarded pieces of paper. Results: An increase in the number of discarded pieces of paper was observed over time. Additionally, some positive changes were observed in her daily life. Conclusion: Exposure and ritual prevention using behavioral measures appeared to be effective for the treatment of this patient with obsessive-compulsive disorder diagnosis that included compulsive checking.

Study objective: To evaluate effects of an intervention involving desensitization and heart rate biofeedback with an older woman who had recurrent panic attacks that were hypothesized to be caused by anticipatory anxiety, and who was unable to separate from her family even momentarily. Setting: The participant’s home. Participant: A woman in her early 90s with panic disorder. Intervention: In condition A, the participant practiced imaginal desensitization during which she imagined a situation in which her family went out and she was left alone. In condition B, she underwent in vivo desensitization of separating from her family as the amount of time they were separated, or that family members went out, was increased gradually. In both conditions, she used a wearable device that enabled her to monitor her heart rate visually and check whether she had achieved the target value. Measures: Heart rate during every day practice. Result: After the intervention, the participant was able to stay by herself for 30 minutes after her family left home. In a follow-up interview 2 months later, it was reported that she was able to stay home alone on weekdays. Conclusion: The combined intervention involving in vivo desensitization and heart rate biofeedback methods appeared to be effective for this older woman diagnosed with panic disorder.

Study Objective: The present study aimed to examine the effects of self-monitoring of early warning signs (EWS) such as the participant’s daily sleep schedule and number of delusions and auditory hallucinations, as a support for prevention of rehospitalization. Design: ABB’+follow-up. Setting: Psychiatric day care outpatient center in a psychiatric hospital. Participant: 1 woman in her fifties with schizophrenia who had a history of hospitalizations. Intervention: In Intervention 1, the participant’s sleep record was checked; she was praised when she had recorded a fixed sleep schedule. In Intervention 2, self-monitoring of her emotions and auditory hallucinations was added; the participant was praised when she recorded coping behavior. In the follow-up period, the participant’s sleep records continued to be checked. Measures: Self-monitored recordings of her social participation, delusion-related behavior, and auditory hallucinations, and also her sleep schedule. Results: After Intervention 1, the participant’s reports indicated that her behavior related to delusions decreased and her social participation increased. The percentage of her behavior that was related to delusions and auditory hallucinations decreased during Intervention 2. In the follow-up, although the participant was hospitalized for 1 month, that occurred only after she had been able to continue living in the community for more than 10 years without other rehospitalization. Conclusions: The interventions that praised continuous self-monitoring of early warning signs by the participant and her sharing her data with the medical support staff appeared to be effective in preventing rehospitalization and increasing her social participation.

The purpose of the present article is to discuss implications, strategies, and impact of Articles and Practical Reports about psychiatric interventions that are published in the Japanese Journal of Behavior Analysis. Articles and Practical Reports are important because they are related to creation of an integrated field and to systematic replications. These articles function to reinforce readers and writers, and to increase interactions between writers and readers. The structure of the articles should include the participants’ symptoms (behavior), life history, and environment; functional and ecological assessments, ethics, research design, dependent variables, intervention methods, results, and discussion, in order to ensure efficient writing, reading, and editing. Comments on the 5 articles in the present issue contend that writing articles leads to realizing behavior wellness by sharing experiences of clinical interventions at various sites.

Study objective: Evaluation of efficacy of dog-training methods intended to help owner-handlers control their dogs appropriately when participating in animal-assisted activities (AAA). Setting: A training room used for behavioral training for animal-assisted activities. Participants: Female volunteers (N=9) in their forties to fifties who wanted to conduct animal-assisted activities with their dogs. The handler-dog pairs were divided into 2 groups based on assessment results: Group 1: pairs (handler plus dog) in which the handlers had not yet acquired appropriate behaviors (n=4), and Group 2: pairs in which the handlers had already acquired relatively appropriate behaviors (n=5). Designs: Group 1: Multiple baseline across behaviors; Group 2: Multiple baseline across participants. Independent variable: Behavioral training, including feedback based on videos of the target behaviors. Measures: Group 1: Target behaviors, including leash handling, instructions to dogs, and a “praising voice”; Group 2: “praising voice.” The handlers’ use of a praising voice was assessed using the A’ of signal detection theory as the index. Other target behaviors were assessed from their percentage of occurrence, defined as the number of observation intervals that included the target behavior divided by the total number of corresponding intervals. Results: In Group 1, all 4 handlers improved significantly in at least 4 of the 5 behaviors measured, including commands and prompts to their dogs. In Group 2, 4 of the 5 handlers’ A’ increased significantly. Moreover, the percentage of occurrence of hits by all 5 handlers increased. Conclusion: The methods employed in the present study may be useful for improving the skills of individuals who are training dogs to participate in animal-assisted activities.

Study objective: Examination of effects of a training program for new estheticians intended to improve customer-service skills. Design: An intergroup multiple baseline design, with interventions in different periods for each of 2 groups. Setting: Group training was conducted in the training room of a beauty-treatment clinic; individual coaching, using social media. Participants: Estheticians (N=12, mean age=22.7 years, SD=1.42) working at an esthetic salon. Intervention: Group social skills training (SST) and individual coaching using social media. The group training was conducted once every 2 weeks, for a total of 5 times. For the individual coaching, the participants were required to submit a self-record sheet on workdays, using social media. The instructors praised the participants when their reported self-assessment of the target behavior was high. When a self-assessment was low, the instructors asked about the conditions, and instructed the participant on points to be improved. Target skills: (a) Interacting behaviors and (b) listening skills. Role-playing scenes were video-recorded before the intervention and during the intervention and follow-up periods, using a counseling sheet. The targeted behaviors were assessed based on video recordings. Results: All participants acquired customer-service skills following the interventions. Moreover, a significant correlation was shown between the percentage of self-record sheets filled out and the rate of change in the listening skills scores. Conclusion: Group training with individual coaching using remote communication tools such as social media is likely to be useful for improving customer service skills of estheticians in a short period.

Study objective: Examination of effects of providing choice opportunities in a learning situation on the off-task behavior of children with severe intellectual disabilities. It was hypothesized that (a) off-task behavior would be reduced by effects of the choice itself, and (b) off-task behavior would be reduced when more than 1 choice opportunity was provided. Design: Alternating treatment design with 3 conditions: no choice (0C), 1 choice (1C), and 2 choices (2C) The no-choice condition was the yoked control for the 2-choices condition. Setting: A room in the participants’ home or a classroom. Participants: 4 children with severe intellectual disabilities and autism spectrum disorders, 6 to 14 years old. Independent variable: Number of choice opportunities (0 to 2). Measure: Off-task percentage measured by the 5-second partial interval recording method. Results: The percentage of intervals that were off-task in the 2-choice condition was lower than that in the no-choice (yoked control) condition in 3 of the 4 participants. Conclusions: Having choices in itself may have resulted in a reduction in the off-task percentage. Although effects of the number of choice opportunities were not clear, it was suggested that effects of having choice opportunities may have been influenced by variables that control choice behavior.

Study objective: The present study investigated effects of proxy-self-monitoring on the behavior of a youth with attention deficit/hyperactivity disorder who, when playing card games in an individual developmental support situation, frequently broke the rules of the card game. Proxy-self-monitoring is a procedure that uses video to evaluate the behavior of others who imitate the behavior of participants. Design: AB probe. Setting: A counseling room at an after-school day service. Participant: A 16-year-old boy with attention deficit/hyperactivity disorder. Intervention: A video of a staff member and another person playing the role of participants in a card game was created. The participant watched the video and then evaluated how much the non-staff member was breaking the rules of the game. Measure: The frequency of the participant’s breaking the rules of card games, analyzed by the partial interval method. Results: The introduction of proxy-self-monitoring immediately reduced the frequency of his rule-breaking behavior. Even after the proxy-self-monitoring was discontinued, his rule-breaking behavior remained at a lower frequency than during baseline. Conclusion: The present study suggests that proxy-self-monitoring may be effective for reducing rule-breaking behavior, as it was when that intervention was applied to the participant’s rule-breaking in a card game.

Study objective: Examination of the effects of teleconsultation for the implementation of classwide positive behavior support in a public elementary school classroom. Designs: ABC and ABCD. Participants: 25 fifth-grade students and their classroom teacher. Intervention: 5 teleconsultation sessions were conducted with the classroom teacher using a videoconferencing system. Classwide practices included the creation and posting of a positive behavior matrix, positive peer reporting at the afternoon homeroom, and behavior-specific praise by the classroom teacher. Measures: Class preparation behavior (percentage of children ready for class before the start of third period), seating behavior (whether all children were seated before the start of third period), and lunch preparation behavior (time from the end of fourth period until the students who were on school lunch duty started walking to the school kitchen) were recorded by the classroom teacher. Results: The percentage of children who were ready for class and the number of days when all children were seated before the start of class increased. Time until the students who were on school lunch duty started walking to the school kitchen decreased. Conclusion: After classwide positive behavior support was implemented with a level of intervention integrity through teleconsultation, children’s target behaviors improved through a combination of matrix posting, positive peer reporting, and behavior-specific praise by the classroom teacher. The results from a questionnaire completed by the children and the classroom teacher supported the social validity of the teleconsultation and classwide practices.