The impact of the quality of behaviour support plans on the use of restraint and seclusion in disability services

Background: Behaviour support plan (BSP) quality is known to be an important aspect of the support provided to people with disability who show challenging behaviours and has been found to lead to reductions in challenging behaviour. Preliminary evidence suggests that quality of plans is associated with reductions in the use of restraint
and seclusion.
Method and materials: Quality of a sample of behaviour support plans was assessed using the Behaviour Support Plan – Quality Evaluation II (BSP-QE II) Guide (Browning Wright, Saren & Mayer, 2003). Episodes of restraint and seclusion before and during implementation of plans were examined by comparing restraint and seclusion use between individuals with high quality versus low quality plans.
Results: Compared to individuals with low quality plans, individuals with high quality plans were found to be subjected to less restraint and seclusion over time, while those with low quality plans were subjected to increases. With the exception of one quality component, all components in high quality plans were found to be associated with decreases in restraint and seclusion use.
Conclusions: The results support earlier preliminary findings that quality of behaviour support plans are associated with reductions in restrictive intervention use. The findings are important because they suggest that increasing quality of behaviour support plans may lead to decreases in restraint and seclusion over time.

Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys

Stice's dual pathway model of dietary restraint and negative affect was examined in both adolescent girls and boys. Self-report measures assessing body dissatisfaction, dietary restraint, negative affect and bulimic behavior were administered to 267 girls and 199 boys aged between 12 and 16 years. The findings for the girls were consistent with Stice's model, in that they indicated that both dietary restraint and negative affect mediated the relationship between body dissatisfaction and bulimic behavior. For the boys who desired a thinner body size, only negative affect was found to mediate the relationship between body dissatisfaction and bulimic behavior. On the other hand, for boys who desired a larger body size, both body dissatisfaction and dietary restraint were found to exert an independent effect on bulimic behavior. As boys can aspire to two contrasting and seemingly opposite body size ideals, the findings highlight that the relationship between body dissatisfaction, dietary restraint, negative affect and bulimic behavior are more complex in males than in females. Further research using longitudinal designs is needed in order to test the directional and bidirectional nature of the observed interrelationships.

Interventions for reducing the use of seclusion in psychiatric facilities : a review of the literature

Background The authors of a recent systematic review concluded that the use of non-pharmacological containment methods, excluding restraint and seclusion, was not supported by evidence. Their focus on randomised, controlled trials, however, does not reflect the research that has been, or could be, conducted.

Aims To find empirically supported interventions that allow reduction in the use of seclusion in psychiatric facilities.

Method We reviewed English-language, peer-reviewed literature on interventions that allow reduction in the use of seclusion.

Results Staff typically used multiple interventions, including state-level support, state policy and regulation changes, leadership, examinations of the practice contexts, staff integration, treatment plan improvement, increased staff to patient ratios, monitoring seclusion episodes, psychiatric emergency response teams, staff education, monitoring of patients, pharmacological interventions, treating patients as active participants in seclusion reduction interventions, changing the therapeutic environment, changing the facility environment, adopting a facility focus, and improving staff safety and welfare.

Conclusions Reducing seclusion rates is challenging andgenerally requires staff to implement several interventions.

Restrictive interventions for people with a disability exhibiting challenging behaviours : analysis of a population database

Background: People with an intellectual disability whose behaviours are perceived to be of serious harm to themselves or others are at risk of being subjected to restrictive interventions. Prevalence rates are difficult to determine, as most research is unable to draw on the results of population-level data.

Method: The current study reports on the use of chemical and mechanical restraint and seclusion in the State of Victoria, Australia, over a 12-month period.

Results: The majority of people included were subjected to chemical restraint. The use of restraint was found to be routine rather than a strategy of last resort. Consistent with findings in the UK and USA, those subjected to restrictive interventions were more likely to be young males with multiple disabilities, including autism.

Conclusions: Systemic policy and procedural developments are needed to address current use of restrictive interventions, together with a longitudinal study to evaluate the effectiveness, of alternative, non-restrictive strategies.

Restraint as misregulation in drinking and eating

The present study was designed to increase our understanding of the co-morbidity between problem drinking and binge eating. The study investigated both consummatory behaviors in relation to restrained drinking, restrained eating, and a general measure of self-control. The participants were a sample of 658 boys and 414 girls aged between 14 and 17 years. The dimension of restraint, which best predicted the two problem behaviors when examined separately for both boys and girls, was cognitive and emotional preoccupation (CEP) about controlling one's consummatory intake. In addition, evidence was found linking both problem drinking and binge eating to restraint and poor general self-control. The struggle with self-control and the high emphasis on CEP about controlling one's consummatory intake, which characterise restrained drinking and restrained eating, closely resembles Baumeister and Heatherton's notion of misregulation [Psychol. Inquiry 7 (1996) 1]. Discussed are the similarities between restraint and misregulation, and the kinds of strategies that can be used to improve self-control.

Use of restraint in residential care settings for children and young people

An international movement promoting the reduced use of physical restraint and other coercive practices has brought into focus the ways in which those who are responsible for the care of children and young people respond to problematic behaviour. The topic generates emotive discussion, with proponents advancing the argument that the use of coercive measures enhances the quality of care and protects young people from harm, and civil libertarians who argue that restraint is never an appropriate way of managing behaviour. Despite such debates there is an absence of good research and scholarly activity on restraint practices, leading to uncertainty about the immediate and long-term effects of particular practices on both staff and young people. Consequently, it has been difficult for agencies to develop clear, consistent, and definitive policies. Drawing on international perspectives, the aim of this article is to discuss issues relevant to the practice of restraint in residential care facilities for children and young people in Australia, highlighting a number of issues that require resolution prior to the development of practice guidelines.

Negative affect as a mediator between body dissatisfaction and extreme weight loss and muscle gain behaviors

Negative affect has been found to mediate the relationship between body dissatisfaction and bulimia. However, it is unknown if this relationship also applies to disordered eating, excessive exercise and strategies to increase muscle for men or women. The aim of this study was to investigate whether negative and positive affect mediate the relationship between body dissatisfaction, and these body change strategies. Respondents were 93 men and 97 women (age range: 18-25 years), who completed measures of body dissatisfaction, positive and negative affect and body change strategies to lose weight or increase muscles. Body dissatisfaction was associated with strategies to lose weight, dietary restraint and bulimia for both genders. Negative affect mediated the relationship between dissatisfaction with muscles and strategies to lose weight, dietary restraint and bulimia for women only. The results confirm previous findings related to the association between negative affect and disordered eating for women. They also demonstrate the need to further investigate the impact of negative affect on body change strategies, particularly among men, and those strategies related to increasing muscles.

Sex-role traits and the comorbidity of symptoms of disordered eating and problem drinking

The symptoms of problem drinking and disordered eating were studied independently in relation to sex-role traits and also for evidence of comorbidity in a student sample of 217 women. The participants completed surveys that assessed positive and negative sex-role traits, reported drinking levels, alcohol dependence, problem drinking, bulimic symptoms, dietary restraint, and drive for thinness. Eating symptoms were related to both the negative and positive traits of Femininity, but self-descriptions involving negative traits (passivity, dependence, unassertiveness, etc.) showed the strongest relationship. High scores on identification with the traits typically labelled as Masculinity were related to drinking but there was an important difference between drinking per se (which was related to Positive Masculinity) and drinking found to be associated with drinking problems, which was related to Negative Masculinity (aggression, showing-off, rudeness, etc.). Feminine traits were also related to drinking. Low identification with the traits of Negative Femininity was associated with non-problem drinking, whereas low identification with the traits of Positive Femininity were associated with problem-related drinking. Young women who displayed comorbid symptoms described themselves by a high identification with the traits of both Negative Masculinity and Negative Femininity. It was argued that comorbidity reveals a more extreme form of the sex-role conflict previously described in relation to disordered control over both eating and drinking when considered independently.

Implications of accuracy, sensitivity, and variability of body size estimations to disordered eating

The current study was conducted to investigate the relationships between body size estimations and disordered eating symptomatology. The method of constant stimuli was used to derive three measures of self-perceived body size in 93 women: (1) accuracy of body size estimations (body image distortion); (2) sensitivity in discriminating body size within blocks of trials (body image sensitivity); and (3) variability in making body size estimations between blocks of trials (body image variability). Participants also completed measures of disordered eating. Although body image distortion correlated with dietary restraint and eating concern, body image variability accounted for additional variance in these variables, as well as variance in binge eating. The relationships involving body image variability were found to be mediated by body dissatisfaction and internalization of the thin ideal. Together, these results are consistent with the proposition that body image variability is a significant factor in disordered eating.

Corporate social responsibility : corporate reputation, business performance and public liability

Corporate Social Responsibility (CSR) may be viewed as a business strategy rather than a philanthropic concept. The increasing use of CSR as a corporate core strategy, in reaction to consumers‘ growing sentiments, can influence aggregate consumption and consumers‘ quality of life. As such, CSR would be of interest to the policy makers and may become subject to corporate governance and control mechanism. CSR is largely unregulated. Reliance on corporations‘ self-restraint and voluntary initiatives is inadequate to protect the society and avoid the disadvantages that may emerge from the potential deceptive practices in using a CSR strategy. This study investigates the evidence of economic benefits as incentives to corporations for using CSR. CSR is measured in terms of the firm‘s relationships with primary stakeholders. A model is constructed to identify the primary stakeholders and to estimate the association between CSR, corporate reputation and business performance. Policy implications of CSR are discussed.

Chronic stress alters the density and morphology of microglia in a subset of stress-responsive brain regions

The current study, in parallel experiments, evaluated the impact of chronic psychological stress on physiological and behavioural measures, and on the activation status of microglia in 15 stress-responsive brain regions. Rats were subjected, for 14 days, to two 30 min sessions of restraint per day, applied at random times each day. In one experiment the effects of stress on sucrose preference, weight gain, core body temperature, and struggling behaviour during restraint, were determined. In the second experiment we used immunohistochemistry to investigate stress-induced changes in ionized calcium-binding adaptor molecule-1 (Iba1), a marker constitutively expressed by microglia, and major histocompatibility complex-II (MHC-II), a marker often expressed on activated microglia, in a total of 15 stress-responsive nuclei. We also investigated cellular proliferation in these regions using Ki67 immunolabelling, to check for the possibility of microglial proliferation. Collectively, the results we obtained showed that chronic stress induced a significant increase in anhedonia, a decrease in weight gain across the entire observation period, a significant elevation in core body temperature during restraint, and a progressive decrease in struggling behaviour within and over sessions. With regard to microglial activation, chronic stress induced a significant increase in the density of Iba1 immunolabelling (nine of 15 regions) and the number of Iba1-positive cells (eight of 15 regions). Within the regions that exhibited an increased number of Iba1-positive cells after chronic stress, we found no evidence of a between group difference in the number of MHC-II or Ki67 positive cells. In summary, these results clearly demonstrate that chronic stress selectively increases the number of microglia in certain stress-sensitive brain regions, and also causes a marked transition of microglia from a ramified-resting state to a non-resting state. These findings are consistent with the view that microglial activation could play an important role in controlling and/or adapting to stress.

Opposing roles for medial and central amygdala in the initiation of noradrenergic cell responses to a psychological stressor

Psychological stressors trigger the activation of medullary noradrenergic cells, an effect that has been shown to depend upon yet-to-be-identified structures located higher in the brain. To test whether the amygdala is important in this regard, we examined the effects of amygdala lesions on noradrenergic cell responses to restraint, and also looked at whether any amygdala cells that respond to restraint project directly to the medulla. Ibotenic acid lesions of the medial amygdala completely abolished restraint-induced Fos expression in A1 and A2 noradrenergic cells. In contrast, lesions of the central amygdala actually facilitated noradrenergic cell responses to restraint. Tracer deposits in the dorsomedial (but not ventrolateral) medulla retrogradely labelled many cells in the central nucleus of the amygdala, but none of these cells expressed Fos in response to restraint. These data suggest for the first time that the medial amygdala is critical to the activation of medullary noradrenergic cells by a psychological stressor whereas the central nucleus exerts an opposing, inhibitory influence upon noradrenergic cell recruitment. The initiation of noradrenergic cell responses by the medial amygdala does not involve a direct projection to the medulla. Accordingly, a relay through some other structure, such as the hypothalamic paraventricular nucleus, warrants careful consideration.

Stressor categorization : acute physical and psychological stressors elicit distinctive recruitment patterns in the amygdala and in medullary noradrenergic cell groups

It has been hypothesized that the brain categorizes stressors and utilizes neural response pathways that vary in accordance with the assigned category. If this is true, stressors should elicit patterns of neuronal activation within the brain that are category-specific. Data from previous immediate–early gene expression mapping studies have hinted that this is the case, but interstudy differences in methodology render conclusions tenuous. In the present study, immunolabelling for the expression of c-fos was used as a marker of neuronal activity elicited in the rat brain by haemorrhage, immune challenge, noise, restraint and forced swim. All stressors elicited c-fos expression in 25–30% of hypothalamic paraventricular nucleus corticotrophin-releasing-factor cells, suggesting that these stimuli were of comparable strength, at least with regard to their ability to activate the hypothalamic–pituitary–adrenal axis. In the amygdala, haemorrhage and immune challenge both elicited c-fos expression in a large number of neurons in the central nucleus of the amygdala, whereas noise, restraint and forced swim primarily elicited recruitment of cells within the medial nucleus of the amygdala. In the medulla, all stressors recruited similar numbers of noradrenergic (A1 and A2) and adrenergic (C1 and C2) cells. However, haemorrhage and immune challenge elicited c-fos expression in subpopulations of A1 and A2 noradrenergic cells that were significantly more rostral than those recruited by noise, restraint or forced swim. The present data support the suggestion that the brain recognizes at least two major categories of stressor, which we have referred to as ‘physical’ and ‘psychological’. Moreover, the present data suggest that the neural activation footprint that is left in the brain by stressors can be used to determine the category to which they have been assigned by the brain.

Restrained eaters consume more food only if they are impulsive and male

This study utilised the preload paradigm to evaluate whether dietary restraint, impulsivity, or their interaction significantly predicts heightened food consumption among male and/or female participants. Following a high calorie preload, 79 participants aged 18 to 40 (53 females and 26 males) completed a deceptive taste test and questionnaires measuring restraint and impulsivity levels. A series of hierarchical regressions were run, controlling for self-rated hunger levels. A significant negative association between level of restraint and food consumption post-preload was found for males, but this relationship was not significant for female participants. The hypothesis that impulsivity would directly predict heightened food consumption was not supported for either gender. However, impulsivity was found to significantly moderate the relationship between restraint and food intake in the male sample, but not the female, providing partial support for this hypothesis. Potential reasons for this gender-specific interaction effect of impulsivity and restraint for food consumption are discussed. More broadly, present findings highlight the need for further consideration of the role of impulsivity in undermining food intake of restrained eaters. Future research should also consider how preload effects may differ across gender.