Behavior analysis, technology, and the super-convergence Jesse Dallery, Ph.D. Professor Dept of Psychology University of Florida
Cyborg An organism to which exogenous components have been added for the purposes of adapting to new environments.
Technology and health behavior Health behavior - Cigarette smoking, physical inactivity, alcohol abuse, unhealthy diet, medication adherence
Morbidity associated with unhealthy behavior
Technology and health behavior Automated hovering over health behavior during every activities (Asch, Muller, & Volpp, 2012)
Automated Hovering Behavior Presence/absence of behavior Ecological Momentary Assessment Physical activity/inactivity Accelerometers Medication adherence Medication Event Monitoring Systems Illicit and licit drug use Fluid- or breath-based detection
Automated nudging Behavior Presence/absence of behavior EMA Physical activity/inactivity accelerometers Medication adherence MEMs Drug taking fluid- or breath-based detection
Automated nudging Antecedents Prompts Goals Instructions Encouragement mobile-phones, Internet, wearable devices Behavior Presence/absence of behavior EMA Physical activity/inactivity accelerometers Medication adherence MEMs Drug taking fluid- or breath-based detection
Automated nudging Antecedents Prompts Goals Instructions Encouragement mobile-phones, Internet, wearable devices Behavior Presence/absence of behavior EMA Physical activity/inactivity accelerometers Medication adherence MEMs Drug taking fluid- or breath-based detection Consequences Monetary consequences Social consequences Conditioned reinforcers (points, badges, graphed progress) mobile-phones, Internet, wearable devices, gaming devices
We have the science, we have the technology, we can re-build a repertoire Contingency Management + Information Technology = Smoking cessation CHOICE Drug Use Abstinence
Contingency management (CM) Consequences contingent on objective evidence (breath carbon monoxide, CO) of smoking abstinence Negative CO Sample $ Voucher $ Goods and services
Potential barriers Response effort: home visits or clinic visits High rate of CO sampling (half- life of breath CO 6 hr) Treatment duration Financial cost Access and dissemination
One Solution Internet-based contingency management - CO monitoring via a web-camera from the participant s home - Low response effort - Sampling can continue on a frequent, sustained basis (2/day, 7/week)
Timeline of experimental conditions Baseline Shaping Abstinence Induction Thinning Return to Baseline Voucher Value ($) 20 15 10 5 0 Ascending, reset, bonuses 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Consecutive Negative CO samples
Internet-based contingency management Dallery, J., Glenn, I., & Raiff, B. R. (2007). An Internet-based voucher reinforcement program for smoking cessation. Drug and Alcohol Dependence, 86, 230-238.
Conclusions Feasible: Over 97% of the 1,120 CO samples were collected Efficacy: Over 65% negative CO samples during abstinence induction condition (out of 400) Dallery & Glenn, 2005; Dallery, Glenn, Raiff, 2007; Glenn & Dallery, 2007,
Technological Enhancements Mike Grabinski, developer Secure, user-friendly website Participants can logon from any computer that has Internet access Only necessary to loan CO monitors and webcameras if needed
Video Submissions Video stream is sent directly to the study server over a secure, encrypted connection Video stream Server in NYC
100 Median percent negative samples 80 60 40 20 0 Contingent (n= 39) Noncontingent (n = 38) Group
Participants
Treatment Acceptability Questionnaire 100 How was the Internet Program? VAS (0= not at all, 100 = very much) Mean + SEM 80 60 40 20 0 Easy Helpful Convenient Effective Fair Question Contingent Noncontingent
Adolescent Smokers Reynolds, Dallery, Shroff, Patak, Leras (2008). A web-based contingency management program with adolescent smokers. JABA.
Adolescent smokers in rural Appalachia Contingent: n = 29 CO ppm: Control: n = 23 CO ppm: NIH Grant: RC1CA144744 PI: B. Reynolds
Adolescent smokers in rural Appalachia Contingent: n = 29 * * CO ppm: 10.6 6.7 4.7 * 5.13 * 6.22 Control: n = 23 CO ppm: 11.2 10 * * 9.75 10.46 9.82 Baseline Shaping Abstinence Thinning Return to Baseline * Significant difference from baseline Significant difference from control group NIH Grant: RC1CA144744 PI: B. Reynolds
Adult smokers in Appalachian Kentucky N=68 Stoops, Dallery, Schoenberg, Fields, Martin, Casey, Nuzzo, Wong (2009). An Internet- Based Smoking Cessation Intervention in Appalachian Kentucky Smokers. Drug and Alcohol Dependence, 105, 56-62.
Previous work at UF Internet-based CM feasible, acceptable, and efficacious Locally-derived samples of participants Grant-funded vouchers Except: Dallery, Meredith, Glenn (2008). A deposit contract method to deliver abstinence reinforcement for cigarette smoking. JABA, 41
Ongoing effectiveness trial Capitalizing on the reach of the Internet: providing access to any qualified smoker in the US Incorporating a deposit contract Possible roles of deposit - Motivational - Deterrent to non-smokers - Cost-offsets
http://www.psych.ufl.edu/ ~ufsmokelab
Deposit and vouchers All participants pay a $50 deposit via PayPal, recouped based on abstinence or CO submissions After $50 has been earned, vouchers are provided for remainder of treatment All vouchers go to participants PayPal accounts
Median 11/10/2011
Participant
11/10/2011
Access
Internet-based group contingencies Social network procedure using small groups (e.g., n=4) of smokers Integrated discussion board into Mōtiv8 architecture All members of a network must meet criteria to receive vouchers shared goals, social support, and potential for sustainability Meredith, S., Grabinski, M., & Dallery, J. (2011). Internet-based group contingencies to promote abstinence from cigarette smoking. Drug and Alcohol Dependence, 118, 23-30.
Results Meredith, S., Grabinski, M., & Dallery, J. (2011). Internetbased group contingencies to promote abstinence from cigarette smoking. Drug and Alcohol Dependence, 118, 23-30. Posts on support forum - 128 total (mean # posts/participant = 9.8, S.D. ± 5.7) - 65% rated positive, 34% neutral, 1% negative (Speltz et al., 1982)
CB MB KK CB: I am positive we can do this---- one step at a time. CO level 50 40 30 20 57% of bonuses earned MB: Let's Make Some Money!!!!!!!!!!!!!!!!!!!!!!!!!!! KK: Great job people! For once we all made it. 10 0 20 0 4 8 12 16 20 24 28 32 15 # of Posts 10 5 0 0 2 4 6 8 10 12 14 16 Day
MC KT BB MC: First day in about 3 years I have left the house without a lighter. CO level 50 40 30 20 29% of bonuses earned KT (in reply to above comment): that's really good! BB: Haven't smoked yet today but got the anxiety and craving...congrats to everyone so far. 10 0 20 0 4 8 12 16 20 24 28 32 15 # of Posts 10 5 0 0 2 4 6 8 10 12 14 16 Day
JY KM ER CO Level # of Posts 50 40 30 20 10 0 20 15 10 29% of bonuses earned 0 4 8 12 16 20 24 28 32 36 JY (didn t hit a tapering goal): Well I suck, missed my goal by one friggin number. I apologize teammates. I really put forth my best efforts today. You guys are doing great! Tomorrow is a new day, and Q-Day, I have no smokes so I wont smoke any. KM: ER, your graph is looking good!! (although a little group participation would be nice ) I only mean that JY and Myself would love to hear from you about how you are doing it and how well you are handling the change. What methods are you using?? Just drop a line from time to time!!! 5 0 0 2 4 6 8 10 12 14 16 18 Day
Growth of the treatment Other behavior - Self-monitoring of blood glucose - Exercise (Kurti & Dallery, 2013) - Medication Adherence - Alcohol Raiff & Dallery (2010). Internet-based contingency management to improve adherence with blood glucose testing recommendations for teens diagnosed with Type 1 diabetes. JABA
Evolution of the treatment R 2 =1.0 Accessibility Time
Future - Making access easier Building prototypes to collect breath CO or salivary cotinine, transmitted via mobile phone User authentication via face recognition or radio frequency identification (RFID)
Selfdeposits Sponsor deposits Individual CM Group CM
Cost Access Contingency Management
Information Technology Internet Mobile phone Access Cost Behavioral Technology Deposit Contracts Social contingencies Other Contingency Management
Dissemination Potential Social Support Tailoring Anonymity Linking Behavioral Science with Technology Temporal Flexibility Treatment Fidelity Cost effectiveness Access
The super-convergence
The super-convergence Digital and Information Technology Health Behavior Behavioral Technology
Behavior analysis, technology, and the superconvergence
Behavior analysis, technology, and the superconvergence Resistance is futile
C4TBH.ORG
Acknowledgments Collaborators Darragh Devine, Ph.D. Mark Gold, M.D. Michael Grabinski, B.A., MCSD Brady Reynolds, Ph.D. Lisa Marsch, Ph.D. Kenneth Silverman, Ph.D. Maxine Stitzer, Ph.D Paul Soto, Ph.D. Conrad Wong, Ph.D. Graduate Students Rachel Cassidy Philip Erb Brantley Jarvis Allison Kurti Matthew Locey Julie Marusich Steven Meredith Bethany Raiff Alana Rojewski Undergraduate Students Tia Bolivar Aaron Dumas Taryn Manders Zaday Sanchez Marissa Turturicci UF Grant Support College of Liberal Arts and Sciences NIH Grant Support R03DA019467 (Dallery) R03DA15373 (Dallery) R21DA015289 (Dallery) R21CA124881 (Wong) R01DA019580 (Dallery) R01DA023469 (Dallery)