Motivating People with Negative Exercise Behaviors to Exercise: FBA to the Rescue

1. Motivating People with Negative Exercise Behaviors to Exercise: FBA to the Rescue Jeannie Golden, Kelli Minton, Lacey Schwab & Jackie Baker East Carolina University

2. PSYC 6353: BEHAVIORAL ASSESSMENT & INTERVENTION • Cipani, E. & Schock, K. (2011). Function Behavior Assessment, Diagnosis, and Treatment: A Complete System for Education and Mental Health Settings New York, NY: Springer Publishing Company • Graduate students in Pediatric School Psychology • Graduate students in Kinesiology

3. Physical Inactivity and Obesity Pandemic Over 20 million kids in America are seriously overweight 55% of adults in the US are overweight or obese These individuals are most susceptible to T2D, HBP, lipid disorders, and CVD 40% of deaths are caused by diabetes By 2030 it’s projected that the US will be 65% obese and estimated 165 million American adults will be obese 1

4. Physical Activity Adherence • PA is constituted as any form of exercise or movement that exerts energy • National Recommendations for adults and PA is 150 minutes/ week minimum of MVPA in 10 minute bouts Nothing is more challenging to the sedentary than adhering to a new exercise program Less than ½ of adults (48%) meet specified recommendations for physical activity (PA) Factors affecting adherence to exercise can be time management, tangible costs, environment, social support, and lack of interest 3 4 2

5. Lacey schwab is a personal trained who works with adults at a gym

6. Target Behaviors Texting during workouts Complaining that exercise is “the devil” Walking around in circles Using the bathroom Falling out on the floor Walking away Purposefully doing the exercise wrong Talking during the workout

8. What’s their function? • Is it escape or access? • Taking my eyes off the client  SMA to adult attention  SME to lengthy/difficult task • Transition to next exercise  SME from aversive stimulus • High intensity exercise/workout  SME from lengthy/difficult task  SMA to tangible item • Challenging workout presented  SME to difficult task • Group Training  SMA to attention and socialization  SME from lengthy tasks, aversive stimulus

9. “Lawd Jesus help me” Gladys would exhibit all kinds of verbal outbursts. Generally it was during any exercise, not particularly related to a specific exercise, exercise in general was aversive to her • “Lacey I’m going to call the police on you for torture” • “Just go ahead and call me an ambulance” • “Ohhhhhh Lacey what are you doing to me” • “Lawd Jesus help me” • “Someone save me, I’m dying”

10. “I’m out” Steve’s target behavior is walking away. Usually because the workout was very challenging and he wanted a break and water Sometimes he would even just sit on the stairs and say I’m out, I’m done I can’t do anything more. His breaks or walk-aways would last for 2-4 minutes or he would disappear for 5min then return to the workout to finish it

11. “BlaBlaBla… BlaBla.. Bla” Nadine does NOT stop talking. She talks when she walks in the door and doesn’t stop until she leaves. She forgets her reps and distracts others when they’re working out Ignoring her or walking away does nothing- she’ll engage in conversation with the nearest client to tell them about the new Bojangles being built in New Bern

12. IN-situ hypothesis testing • Time spent observing: 8 sessions/ month for 30 minutes each (estimated 280min+) • Control Condition: 3 workouts, 1-2 workouts prescribed as always, making the target behavior occur just as frequently; 15s rest breaks will be given at time of target behavior • Intervention Condition: In order to reduce the likelihood of it the target behavior occurring, if they didn’t exhibit any target behaviors, they are reinforced by having a shorter workout that day and choosing whatever they want to do to finish up the workout or even be done completely and not do any exercises • Compare the two conditions

13. SME: exercise • Studies show in classroom settings higher levels of inappropriate behavior may be maintained by escape or avoidance when there’s a mismatch in level of ability and presented task SME: Escape from unpleasant situations, lengthy or difficult tasks, or aversive stimulus Topographies can be the same when comparing SME from clients but the function of the escape behavior is different for each individual The antecedent can be similar but the outcome of the behavior is unique and varies for each individual 7 6

14. Gladys- SME: Lengthy Tasks • To make sure what I was doing worked for her TB, a 3rd trial was completed • She did a tabata style workout with 15sW/15sR and still chose the ending exercise • Reps were increased, aversive exercises were used • She was given 15s rest breaks after every 10 reps and got to pick what she ended the workout with

15. Steve- SME: difficult tasks • He did a tabata style workout with contingent rest given at 20s intervals, and was also allowed a 2min rest in between rounds • He never walked away from the workout • I did a 3rd trial to see if what I was doing was working with no contingent rest • He took 3 breaks for less than 20s for all 10 rounds

16. Nadine- SME: Aversive stimulus • Nadine’s second trial was a failed attempt • Tabata (taking away difficulty of counting) was not aversive to her • I gave huge period of talk time (NCR) in the beginning but it fueled the fire for minimum of 1min talking then took a huge talk break for over 3min after her plank taps • For her 3rd trial I increased the complexity of the exercises and stayed nearby for assistance • She was given talk time for her warm up and only engaged in less than 30s talk time during the entire workout • She also picked her final exercise

17. Making the target behavior irrelevant, inefficient, ineffective • For Gladys, her aversive stimuli was the number of reps she felt like she had to do all at once. When broken up into 10 reps, I prevented the TB. By adding in DRO, Gladys was reinforced for not engaging in her verbal outbursts and also picked exercises that challenged her vs. the easy way out irrelevant; ineffective • For Steve, exercising sometimes was just too difficult. When he was able to contingently receive rest breaks, he quit walking away from the aversive tasks and still maintained the intensity. By teaching him an escape mand, he now requests to go get a sip of water when he completes X amount of reps  inefficient • In Nadine’s case, she loves to chat and exercising is where she can use her talking and take her mind off of the tasks she’s presented with. Once I found out the function of her TB, I knew I needed to make exercises a little more complex for her needs. Focusing became a major challenge and talking dramatically decreased. Using Premack, the workout is still getting done along with her ability to still be able to talk just not as often as before  irrelevant

18. Behavioral Functions in a sports setting Presentation by: Jackie Baker

19. Jackie baker has been A GYMNASTIC COACH for ten years

20. Functional behavioral assessments: • In class she learned that functional behavioral assessments can be conducted within… • A classroom setting • An exercise setting • Then she realized that as a coach, functional behavioral assessments would likely be beneficial in a… • Sports setting, as well!

21. “flipping out” over gymnastics! • All sports impose different psychologically-taxing demands on their athletes. Competitive athletes must display: • Physical • Emotional • Psychological Strength • Gymnastics, specifically, has been found to impose especially high demands on their athletes. These high psychological demands have been associated with: • High prevalence of disordered eating (Sundgot-Borgen & Torstveit, 2004) • High drop-out rates (Ryska, Hohensee, Cooley, & Jones, 2002) • Other psychological issues stemming from low self-esteem (Obeid et al., 2013)

22. How can functional behavioral assessments help? • Perhaps, identifying the functions of target behaviors may help in the prevention of the development of high-risk behaviors and psychological disorders • Has this been demonstrated? But! That would be an interesting topic for future research!

23. Team: Rosette’s Moderately Competitive Level 3-4 Team. Practice 3-4 days a week, compete in ~7 competitions per season. Baby steps… Participant: Emily 12 years of age, has practiced gymnastics for a total of five years. I have been her coach for the past two years. Problem: Round-off backhandsprings

24. Round-off Backhandspring?

25. Target behavior • Operational Definition: Physical refusal to perform a round-off backhandspring on the floor apparatus. • The gymnast successfully completes the practice stations and will also successfully perform the skill on a trampoline surface.

26. Previously… • When the gymnast began exhibiting the target behavior, I originally provided: • Adult attention • Peer attention • Direct Access (water, stickers, candy) • Punishment (push-ups, rope climbs, etc.) • Did they work? NO!

27. Functions to RULE OUT • SMA: Adult Attention- was receiving by exhibiting target behavior (refusing) but was also receiving SME or delay by refusing difficult task • SMA: Peer Attention- was receiving by exhibiting target behavior (refusing) but was also receiving SME or delay by refusing difficult task • SMA: Tangible Reinforcer- was not willing to complete the difficult task to receive access to these tangible items

28. HYPOTHESIZED FUNCTION • My hypothesis was that the function of the behavior was: • Socially Mediated Escape from a Difficult Task

29. In-Situ Hypothesis testing • To test the hypothesis, she compared the occurrences of the target behavior during baseline conditions to occurrences of the target behavior during experimental conditions • Baseline condition: She requested the gymnast to perform the skill, and did not provide any instruction, forms of encouragement, or forms of escape • Experimental condition: She provided SME from a Difficult Task by allowing a one-minute break after one successful performance of the skill

30. Data

31. Hypothesized Functionwas correct • Socially Mediated Escape from a Difficult Task

32. Functional Behavioral Treatment Protocol: • The gymnast IS capable of performing the task, and also displays high levels of motivation, therefore I decided to implement: • Premack Contingency Option

34. Results: • Target behavior ceased to occur after implementation of the PremackContingency • The target behavior became ineffective, since the target behavior did not produce the reinforcer • The target behavior became irrelevant, since reinforcement was provided after each skill completion anyway • Bonus: • The gymnast gained confidence! • After the fourth week of the intervention, the gymnast no longer considered the task to be difficult and performed the skill with ease

35. Moral of the story: • If the gymnast feels successful in their abilities, Jackie feels successful as a coach

36. Project Mentor: Adolescents with Obesity • Kelli Mentor was the Project Director • Undergraduate students are trained as mentors to motivate adolescents to exercise • Training consisted primarily of Motivational Interviewing • Kelli enrolled in my class and decided that FBA should be a part of the training • Kinesiology professor and undergraduate students agreed that it was a valuable addition to the program

37. KELLI MINTON’S PROJECT • The following is Kelli’s project that was conducted in Project Mentor

38. Importance of Physical Activity • “Youth who are active typically have a better chance at adulthood” (CDC, 2003) • An international consensus statement suggests that adolescents accumulate both moderate activity (at least 30 min/d, 5 d/wk) and vigorous activity (at least 20 min/d, 3 d/wk)

39. Current Levels of Exercise Among Adolescents • Questionnaire data indicate that as many as 20 to 50% of teens get insufficient physical activity and 6 to 12% perform no moderate or vigorous activity (Corbin, Pangrazu & Le Masurier, 2004) • N=375 school-age youth wore accelerometers • grades 10–12, only 34.1% and 25.1% of males and females, met this guideline: grades 1-3 100% (Pate et al., 2002)

40. Parameters • 85th percentile is considered ‘‘risk of overweight,’’ and a BMI 95th percentile is defined as overweight. The labels ‘‘overweight’’ and ‘‘obesity,’’ respectively, are often used in the literature. • For youth who have been physically inactive, an incremental approach to the 60-minute goal is recommended. Increasing activity by 10% per week, an approach used in athletic training, appears to be acceptable and achievable. Attempting to achieve too much too rapidly is often counterproductive and may lead to injury.  • (Strong et al, 2005)

41. FBA—behaviors all serve a function • How does behavioral assessment differ from ‘traditional’ methods of behavior change and interventions? • Roll with Resistance • Is the client ‘motivated’? • Check the Environment

42. FBA: All Behaviors Serve a Function • How does behavioral assessment differ from ‘traditional’ methods of behavior change and interventions? • Roll with Resistance • Is the client ‘motivated’? • Check the Environment

43. Replacement Behavior • Identify another behavior that could serve the same need in a ‘better’ way • This should be a ‘win-win’ • Examples: • Get Out of Jail Free Card (Noncontingent Escape) • Grandma’s Rule (Premack) • Thinning the Schedule (DRL)

44. A-B-C of Assessment

45. Identify the Function • Hugs instead of running = access [attention] and escape [from difficult task] • Asking “WHY” = access [information] and escape [from aversive physical stimulus] • Walking away (with attitude) = access [attention] and escape [from aversive situation] • Complains exercise is ‘hurting’ = escape [aversive physical stimulus or difficult task] • Runs and Hides = access [to socializing and attention from peers/mentors]

46. Participant: Alan • Young- 12 years old • Sedentary- has never exercised in his life • Obesity- at 95%ile for weight • BMI is 32 • Pre-hypertensive

47. Target Behavior & ABC Analysis • Whenever something gets too hard and his heart-rate gets above 180 bpm (doing aerobic exercise) he complains that it is too hard and stops • The mentor plays games, does circuits, anything fun she can think of! • Alan really gets into them, until he hits the threshold that is really beginning to work on his Cardiovascular system. • At that time, he withdraws, complains, and stops working continually

48. Target Behavior & ABC Analysis • Objectively defined: stopping all movement for longer than 30 seconds • A: heart rate reaches 70% VO2 Max (mod-vig intensity) • B: ceasing all activity • C: does not meet exercise goal for the day • Through Partial Interval data we recognize this behavior occurs every 15 minutes in a 100 minute session.

49. Interval Recording Data: 15-Minute Intervals

50. Interbehavior-Interval Ceasing all activity for more than 30 seconds because heart rate exceeded 180 bpm • Frequency Data Form– 200 minute total observation time: 100 minute session length • 200 minutes/15 intervals = 13.33 minutes occurring • Intercept the behavior within 80% of the time frame, beginning even slower if necessary. That means, we will allow a non-contingent break every 7-8 minutes for 4 minutes.