Translational Behavioral Medicine

, Volume 4, Issue 3, pp 290–303 | Cite as

Optimizing behavioral health interventions with single-case designs: from development to dissemination

Essay/Opinion Piece

Abstract

Over the past 70 years, single-case design (SCD) research has evolved to include a broad array of methodological and analytic advances. In this article, we describe some of these advances and discuss how SCDs can be used to optimize behavioral health interventions. Specifically, we discuss how parametric analysis, component analysis, and systematic replications can be used to optimize interventions. We also describe how SCDs can address other features of optimization, which include establishing generality and enabling personalized behavioral medicine. Throughout, we highlight how SCDs can be used during both the development and dissemination stages of behavioral health interventions.

Keywords

Generality Optimization Research designs Single-case designs 

Notes

Acknowledgments

We wish to thank Paul Soto for comments on a previous draft of this manuscript. Preparation of this paper was supported in part by Grants P30DA029926 and R01DA023469 from the National Institute on Drug Abuse.

Conflict of interest

The authors have no conflicts of interest to disclose.

References

  1. 1.
    Biglan A, Ary D, Wagenaar AC. The value of interrupted time-series experiments for community intervention research. Prev Sci. 2000; 1(1): 31–49.PubMedCrossRefGoogle Scholar
  2. 2.
    Collins LM, Murphy SA, Nair VN, et al. A strategy for optimizing and evaluating behavioral interventions. Ann Behav Med. 2005; 30(1): 65–73. PMID: 16009093.PubMedCrossRefGoogle Scholar
  3. 3.
    Dallery J, Cassidy RN, Raiff BR. Single-case experimental designs to evaluate novel technology-based health interventions. J Med Internet Res; 2013; 15(2). doi:10.2196/jmir.2227.
  4. 4.
    Guyatt GH, Haynes RB, Jaeschke RZ, et al. Users’ guides to the medical literature: XXV. Evidence-based medicine: principles for applying the Users’ guides to patient care. Evidence-based medicine working group. JAMA. 2000; 284(10): 1290–1296. PMID: 10979117.PubMedCrossRefGoogle Scholar
  5. 5.
    Guyatt GH, Heyting A, Jaeschke R, et al. N of 1 randomized trials for investigating new drugs. Control Clin Trials. 1990; 11(2): 88–100. PMID: 2161315.PubMedCrossRefGoogle Scholar
  6. 6.
    Williams BA. Perils of evidence-based medicine. Perspect Biol Med. 2010; 53(1): 106–120. PMID: 20173299.PubMedCrossRefGoogle Scholar
  7. 7.
    Mercer SL, DeVinney BJ, Fine LJ, et al. Study designs for effectiveness and translation research: identifying trade-offs. Am J Prev Med. 2007; 33(2): 139–154. PMID: 17673103.PubMedCrossRefGoogle Scholar
  8. 8.
    Riley WT, Glasgow RE, Etheredge L, et al. Rapid, responsive, relevant (R3) research: a call for a rapid learning health research enterprise. Clin Transl Med 2013; 2(1): 10-1326-2-10. PMID: 23663660.Google Scholar
  9. 9.
    Rivera DE, Pew MD, Collins LM. Using engineering control principles to inform the design of adaptive interventions: a conceptual introduction. Drug Alcohol Depend. 2007; 88(Suppl 2): S31–S40. PMID: 16009093.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Kumar S, Nilsen WJ, Abernethy A, et al. Mobile health technology evaluation: the mhealth evidence workshop. Am J Prev Med. 2013; 45(2): 228–236. PMID: 23867031.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Riley WT, Rivera DE, Atienza AA, et al. Health behavior models in the age of mobile interventions: are our theories up to the task? Transl Behav Med. 2011; 1(1): 53–71. PMID: 21796270.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Rounsaville BJ, Carroll KM, Onken LS. A stage model of behavioral therapies research: getting started and moving on from stage I. Clin Psychol: Sci Pract. 2001; 8(2): 133–142.Google Scholar
  13. 13.
    Cohen J. The earth is round (p < .05). Am Psychol. 1994; 49(12): 997–1003.CrossRefGoogle Scholar
  14. 14.
    Morgan DL, Morgan RK. Single-participant research design: bringing science to managed care. Am Psychol. 2001; 56(2): 119–127.PubMedCrossRefGoogle Scholar
  15. 15.
    Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Ann Rev Clin Psychol. 2008; 4: 1–32.CrossRefGoogle Scholar
  16. 16.
    Marsch LA, Dallery J. Advances in the psychosocial treatment of addiction: the role of technology in the delivery of evidence-based psychosocial treatment. Psychiatr Clin North Am. 2012; 35(2): 481–493.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Lillie EO, Patay B, Diamant J, et al. The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? Per Med. 2011; 8(2): 161–173. PMID: 21695041.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Goodwin MS, Velicer WF, Intille SS. Telemetric monitoring in the behavior sciences. Behav Res Methods. 2008; 40(1): 328–341. PMID: 18411557.PubMedCrossRefGoogle Scholar
  19. 19.
    Dallery J, Raiff BR. Contingency management in the 21st century: technological innovations to promote smoking cessation. Subst Use Misuse. 2011; 46(1): 10–22.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Aeschleman SR. Single-subject research designs: some misconceptions. Rehabil Psychol. 1991; 36(1): 43–49.CrossRefGoogle Scholar
  21. 21.
    Dermer ML, Hoch TA. Improving descriptions of single-subject experiments in research texts written for undergraduates. Psychol Rec. 1999; 49(1): 49–66.Google Scholar
  22. 22.
    Dixon MR. Single-subject research designs: dissolving the myths and demonstrating the utility for rehabilitation research. Rehabil Educ. 2002; 16(4): 331–343.Google Scholar
  23. 23.
    Kravitz RL, Paterniti DA, Hay MC, et al. Marketing therapeutic precision: potential facilitators and barriers to adoption of n-of-1 trials. Contemp Clin Trials. 2009; 30(5): 436–445. PMID: 19375521.PubMedCrossRefGoogle Scholar
  24. 24.
    Dallery J, Glenn IM, Raiff BR. An internet-based abstinence reinforcement treatment for cigarette smoking. Drug Alcohol Depend. 2007; 86(2–3): 230–238. PMID: 16930854.PubMedCrossRefGoogle Scholar
  25. 25.
    Silverman K, Higgins ST, Brooner RK, et al. Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy. Arch Gen Psychiatry. 1996; 53(5): 409–415.PubMedCrossRefGoogle Scholar
  26. 26.
    Sidman M. Tactics of Scientific Research. Oxford: Basic Books; 1960.Google Scholar
  27. 27.
    Kazdin AE. Single-Case Research Designs: Methods for Clinical and Applied Settings. 2nd ed. New York: Oxford University Press; 2011. ISBN 978-0-19-534188-1.Google Scholar
  28. 28.
    Barlow DH, Nock MK, Hersen M. Single Case Experimental Designs: Strategies for Studying Behavior Change. 3rd ed. Boston: Allyn & Bacon; 2009.Google Scholar
  29. 29.
    Horner RH, Carr EG, Halle J, et al. The use of single-subject research to identify evidence-based practice in special education. Except Child. 2005; 71(2): 165–179.CrossRefGoogle Scholar
  30. 30.
    Tate RL, McDonald S, Perdices M, et al. Rating the methodological quality of single-subject designs and n-of-1 trials: introducing the single-case experimental design (SCED) scale. Neuropsychol Rehab. 2008; 18(4): 385–401.CrossRefGoogle Scholar
  31. 31.
    Kratochwill TR, Hitchcock JH, Horner RH, et al. Single-case intervention research design standards. Remedial Spec Educ. 2013; 34(1): 26–38.CrossRefGoogle Scholar
  32. 32.
    Risley TR, Wolf MM. Strategies for analyzing behavioral change over time. In: Nesselroade J, Reese H, eds. Life-Span Developmental Psychology: Methodological Issues. New York: Academic; 1972: 175.Google Scholar
  33. 33.
    Barlow DH, Hersen M. Single-case experimental designs: uses in applied clinical research. Arch Gen Psychiatry. 1973; 29(3): 319–325.PubMedCrossRefGoogle Scholar
  34. 34.
    Hartmann D, Hall RV. The changing criterion design. J Appl Behav Anal. 1976; 9(4): 527–532.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Kurti AN, Dallery J. Internet-based contingency management increases walking in sedentary adults. J Appl Behav Anal. 2013; 46(3): 568–581.Google Scholar
  36. 36.
    Francisco VT, Butterfoss FD. Social validation of goals, procedures, and effects in public health. Health Promot Pract. 2007; 8(2): 128–133.PubMedCrossRefGoogle Scholar
  37. 37.
    Foster SL, Mash EJ. Assessing social validity in clinical treatment research: issues and procedures. J Consult Clin Psychol. 1999; 67(3): 308–319.PubMedCrossRefGoogle Scholar
  38. 38.
    Schwartz IS, Baer DM. Social validity assessments: is current practice state of the art? J Appl Behav Anal. 1991; 24(2): 189–204.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Wolf MM. Social validity: the case for subjective measurement or how applied behavior analysis is finding its heart. J Appl Behav Anal. 1978; 11(2): 203–214.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Parsonson BS, Baer DM. The visual analysis of data, and current research into the stimuli controlling it. In: Single-Case Research Design and Analysis: New Directions for Psychology and Education. Hillsdale: Lawrence Erlbaum Associates, Inc; 1992; 15–40.Google Scholar
  41. 41.
    Hubbard R, Lindsay RM. Why P values are not a useful measure of evidence in statistical significance testing. Theory Psychol. 2008; 18(1): 69–88.CrossRefGoogle Scholar
  42. 42.
    Lambdin C. Significance tests as sorcery: science is empirical—significance tests are not. Theory Psychol. 2012; 22(1): 67–90.CrossRefGoogle Scholar
  43. 43.
    Fisher WW, Kelley ME, Lomas JE. Visual aids and structured criteria for improving inspection and interpretation of single-case designs. J Appl Behav Anal. 2003; 36(3): 387–406.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Fisher JD, Fisher WA, Amico KR, et al. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006; 25(4): 462–473.PubMedCrossRefGoogle Scholar
  45. 45.
    Kahng S, Chung K, Gutshall K, et al. Consistent visual analyses of intrasubject data. J Appl Behav Anal. 2010; 43(1): 35–45.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Van D, Onghena P. The aggregation of single-case results using hierarchical linear models. Behav Analyst Today. 2007; 8(2): 196–209.Google Scholar
  47. 47.
    Gorman BS, Allison DB, et al. Statistical alternatives for single-case designs. In: Franklin RD, Allison DB, Gorman BS, eds. Design and Analysis of Single-Case Research. Hillsdale: Lawrence Erlbaum Associates, Inc; 1996: 159–214.Google Scholar
  48. 48.
    Jenson WR, Clark E, Kircher JC, et al. Statistical reform: evidence-based practice, meta-analyses, and single subject designs. Psychol Sch. 2007; 44(5): 483–493.CrossRefGoogle Scholar
  49. 49.
    Ben-Zeev D, Ellington K, Swendsen J, et al. Examining a cognitive model of persecutory ideation in the daily life of people with schizophrenia: a computerized experience sampling study. Schizophr Bull. 2011; 37(6): 1248–1256.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Huitema BE. Autocorrelation in applied behavior analysis: a myth. Behav Assess. 1985; 7(2): 107–118.Google Scholar
  51. 51.
    Wilkinson L. Statistical methods in psychology journals: guidelines and explanations. Am Psychol. 1999; 54(8): 594–604.CrossRefGoogle Scholar
  52. 52.
    Manolov R, Solanas A, Sierra V, et al. Choosing among techniques for quantifying single-case intervention effectiveness. Behav Ther. 2011; 42(3): 533–545.PubMedCrossRefGoogle Scholar
  53. 53.
    Parker RI, Vannest KJ, Davis JL. Effect size in single-case research: a review of nine nonoverlap techniques. Behav Modif. 2011; 35(4): 303–322.PubMedCrossRefGoogle Scholar
  54. 54.
    Mason LL. An analysis of effect sizes for single-subject research: a statistical comparison of five judgmental aids. J Precis Teach Celeration. 2010; 26: 3–16.Google Scholar
  55. 55.
    Duan N, Kravitz RL, Schmid CH. Single-patient (n-of-1) trials: a pragmatic clinical decision methodology for patient-centered comparative effectiveness research. J Clin Epidemiol. 2013; 66(8 Suppl): S21–S28. PMID: 23849149.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Hedges LV, Pustejovsky JE, Shadish WR. A standardized mean difference effect size for single case designs. Res Synth Methods. 2012; 3(3): 224–239.CrossRefGoogle Scholar
  57. 57.
    Shadish WR, Hedges LV, Pustejovsky JE, et al. A d-statistic for single-case designs that is equivalent to the usual between-groups d-statistic. Neuropsychol Rehabil. 2013 doi:10.1080/09602011.2013.819021.
  58. 58.
    Wang S, Cui Y, Parrila R. Examining the effectiveness of peer-mediated and video-modeling social skills interventions for children with autism spectrum disorders: a meta-analysis in single-case research using HLM. Res Autism Spectr Disord. 2011; 5(1): 562–569.CrossRefGoogle Scholar
  59. 59.
    Davis JL, Vannest KJ. Effect size for single case research a replication and re-analysis of an existing meta-analysis. Rem Spec Educ. In press.Google Scholar
  60. 60.
    Ganz JB, Parker R, Benson J. Impact of the picture exchange communication system: effects on communication and collateral effects on maladaptive behaviors. Augment Altern Commun. 2009; 25(4): 250–261.PubMedCrossRefGoogle Scholar
  61. 61.
    Vannest KJ, Davis JL, Davis CR, et al. Effective intervention for behavior with a daily behavior report card: a meta-analysis. Sch Psychol Rev. 2010; 39(4): 654–672.Google Scholar
  62. 62.
    Zucker DR, Ruthazer R, Schmid CH. Individual (N-of-1) trials can be combined to give population comparative treatment effect estimates: methodologic considerations. J Clin Epidemiol. 2010; 63(12): 1312–1323. PMID: 20863658.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Branch MN, Madden GJ, Hackenberg T. Generality and Generalization of Research Findings. In: Madden GJ, Hackenberg T, Lattal KA, eds. APA Handbook of Behavior Analysis. Washington: American Psychological Association; 2011.Google Scholar
  64. 64.
    Jaeschke R, Singer J, Guyatt GH. Measurement of health status ascertaining the minimal clinically important difference. Control Clin Trials. 1989; 10(4): 407–415. PMID: 2691207.PubMedCrossRefGoogle Scholar
  65. 65.
    Wright A, Hannon J, Hegedus EJ, et al. Clinimetrics corner: a closer look at the minimal clinically important difference (MCID). J Man Manip Ther. 2012; 20(3): 160–166. PMID: 23904756.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Kaplan RM, Stone AA. Bringing the laboratory and clinic to the community: mobile technologies for health promotion and disease prevention. Annu Rev Psychol. 2013; 64: 471–498.PubMedCrossRefGoogle Scholar
  67. 67.
    Gulley V, Northup J, Hupp S, et al. Sequential evaluation of behavioral treatments and methylphenidate dosage for children with attention deficit hyperactivity disorder. J Appl Behav Anal. 2003; 36(3): 375–378. PMID: 14596580.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Rapport MD, Murphy HA, Bailey JS. Ritalin vs. response cost in the control of hyperactive children: a within-subject comparison. J Appl Behav Anal. 1982; 15(2): 205–216.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Ward-Horner J, Sturmey P. Component analyses using single-subject experimental designs: a review. J Appl Behav Anal. 2010; 43(4): 685–704.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Sanders SH. Component analysis of a behavioral treatment program for chronic low-back pain. Behav Ther. 1983; 14(5): 697–705.CrossRefGoogle Scholar
  71. 71.
    Collins LM, Murphy SA, Strecher V. The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent ehealth interventions. Am J Prev Med. 2007; 32(5): S112–S118.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Raiff BR, Dallery J. Internet-based contingency management to improve adherence with blood glucose testing recommendations for teens with type 1 diabetes. J Appl Behav Anal. 2010; 43(3): 487–491.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Valentine JC, Biglan A, Boruch RF, et al. Replication in prevention science. Prev Sci. 2011; 12(2): 103–117. PMID: 17210552.PubMedCrossRefGoogle Scholar
  74. 74.
    Reynolds B, Dallery J, Shroff P, et al. A web-based contingency management program with adolescent smokers. J Appl Behav Anal. 2008; 41(4): 597–601.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Johnston JM, Pennypacker Jr. HS. Strategies and Tactics of Behavioral Research (3rd ed). New York: Routledge/Taylor & Francis Group; 2009.Google Scholar
  76. 76.
    Topol EJ. The Creative Destruction of Medicine How the Digital Revolution Will Create Better Health Care. New York: Basic Books; 2012.Google Scholar
  77. 77.
    Hayes SC. Single case experimental design and empirical clinical practice. J Consult Clin Psychol. 1981; 49(2): 193–211.PubMedCrossRefGoogle Scholar
  78. 78.
    Blampied NM. In: Madden GJ, Dube WV, Hackenberg TD, eds. Single-Case Research Designs and the Scientist-Practitioner Ideal in Applied Psychology. Washington: American Psychological Association; 2013: 177–197.Google Scholar
  79. 79.
    Cooper JO, Heron TE, Heward WL. Applied Behavior Analysis. Upper Saddle River. NJ: Prentice Hall; 2007.Google Scholar
  80. 80.
    Hanley GP. Functional assessment of problem behavior: dispelling myths, overcoming implementation obstacles, and developing new lore. Behav Anal Pract. 2012; 5(1): 54–72.PubMedPubMedCentralGoogle Scholar
  81. 81.
    Parker RI, Brossart DF. Phase contrasts for multiphase single case intervention designs. Sch Psychol Q. 2006; 21(1): 46–61.CrossRefGoogle Scholar
  82. 82.
    Silverman K, Wong CJ, Higgins ST, et al. Increasing opiate abstinence through voucher-based reinforcement therapy. Drug Alcohol Depend. 1996; 41(2): 157–165.PubMedCrossRefGoogle Scholar
  83. 83.
    Dallery J, Raiff BR. Delay discounting predicts cigarette smoking in a laboratory model of abstinence reinforcement. Psychopharmacology. 2007; 190(4): 485–496.PubMedCrossRefGoogle Scholar
  84. 84.
    Johnston MV, Smith RO. Single subject designs: current methodologies and future directions. OTJR: Occupation, Particip Health. 2010; 30(1): 4–10.Google Scholar

Copyright information

© Society of Behavioral Medicine 2014

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of FloridaGainesvilleUSA
  2. 2.Department of PsychologyRowan UniversityGlassboroUSA

Personalised recommendations