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This technique, called stimulus control, involves changing the frequency of a maladaptive conditioned response by controlling the frequency or intensity of exposure to the stimulus that elicits the response. For example, the person who drinks too much in bars would refrain from going to bars; the person who binges after eating even a bit of dessert might avoid buying desserts or going into bakeries. Stimulus control will be described more fully when we discuss treatment for substance abuse (Chapter 9). As part of behavioral treatment, someone with bulimia may use stimulus control initially to limit her intake of foods that she is likely to purge. If she habitually purges after eating cookies, for instance, she may want to avoid eating-or buying-cookies. Once she is out of the habit of purging, she may use exposure with response prevention to learn to eat cookies without purging. The Role of Operant Conditioning in Behavior Therapy Whereas classical conditioning methods can be used to decrease maladaptive behaviors related to conditioned emotional responses, operant conditioning techniques can be used to modify maladaptive behaviors more generally. When operant conditioning principles such as reinforcement and punishment are used to change maladaptive behaviors, the process is called behavior modification. Making Use of Reinforcement and Punishment the key to successful behavior modification is setting appropriate response contingencies, which are the specific consequences that follow maladaptive or desired behaviors. It is these specific consequences (namely, reinforcement or punishment) that modify an undesired behavior. The goal of behavior modifi cation is to have someone perform a desired behavior more often or perform an undesired behavior less often (or not at all) by shifting the consequences of the behavior through reinforcement, removing reinforcement, or-less frequently-through punishment. Some behaviors are too complex to learn or perform immediately and must be developed gradually. They may not be able to go from their daily intake of perhaps a serving of yogurt, a glass of milk, an egg white and a piece of fruit to three square meals a day along with a snack or two between meals. Sometimes the desired behavior change (in this case, resuming normal eating) can only occur gradually, and reinforcement follows small and then increasingly larger components of the desired new complex behavior. Thus, a woman recovering from anorexia nervosa might be reinforced for increasing her dinner from only a glass of milk and an apple to also include a small helping of fish. On subsequent meals, she might be expected to eat the fish (without reinforcement) and be reinforced for adding a piece of bread. Exposure with response prevention the behavioral technique in which a patient is carefully prevented from engaging in his or her usual maladaptive response after being exposed to a stimulus that usually elicits the response. Stimulus control the behavioral technique for changing the frequency of a maladaptive conditioned response by controlling the frequency or intensity of exposure to the stimulus that elicits the response. Behavior modification the use of operant conditioning principles to change maladaptive behavior. Making Use of Extinction In addition to using reinforcement and punishment, therapists also rely on the principle of extinction, which is the process of eliminating a behavior by not reinforcing it. This man only gets anxious in certain types of social situations, such as going to a party where there will be unfamiliar people. Therapist and patient might decide that the maladaptive behavior to change is his complaining, because it leads his wife to decline the invitation (or to leave him at home). That is, when he complains about parties, she should ignore these comments, and they both then go to the party. The date, day of the week, and time of day can help the patient to identify triggers related to time. Information about the context can help the patient to identify whether particular situations or environments have become conditioned stimuli. Identifying thoughts, feelings, interactions with others, or other stimuli that triggered the problematic behavior (right-hand column in Figure 4. Daily self-monitoring logs are used in treatments for anxiety, poor mood, smoking, compulsive gambling, overeating, and sleep problems, among others. Behavioral techniques that rely on operant conditioning principles are often used in inpatient psychiatric units, where clinicians can intensively monitor and treat patients 24 hours a day, 7 days a week. Under these conditions, caregivers can change the response contingencies for desired and undesired behavior.

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Thus, when investigators test the effects of any new medicine or other biomedical treatment, they invariably use some type of placebo treatment as a comparison. They may also include additional comparison groups, in which patient receive more established treatments, and researchers will likely use a double-blind design. Not all researchers are convinced, however, that patients and clinicians are truly "blind" in double-blind studies. In double-blind studies of medications for depression and anxiety, for instance, both patients and ("blind") clinicians may correctly guess whether patients are receiving a placebo or active medication based on the presence of side effects and changing symptoms (Margraf et al. Some researchers have suggested that in order to evaluate the results of doubleblind studies of medication, investigators should determine whether patients and their clinicians were actually blind to the treatment that the patients received (Piasecki et al. Furthermore, some researchers also advocate using an active placebo-a placebo that mimics the side effects of an active medication but does not directly affect the psychological symptoms of the disorder being treated (Kirsch, Scoboria, & Moore, 2002; Moncrieff, 2001). For instance, when studying the effects of a tricyclic antidepressant, an investigator might use as an active placebo an antihistamine-an over-the-counter cold medicine that has some side effects that are similar to those of tricyclics. The fact that people who suffer from certain disorders, including depression, sometimes improve following a placebo treatment (Kirsch, Scoboria, & Moore, 2002) does not mean that their problem was imaginary, or that they should throw away their medication. Rather, it seems that-for some people and for some disorders-the hope and positive expectations that go along with taking a medication (or undergoing a procedure) allow the body to mobilize its own resources to function better (Kirsch & Lynn, 1999; Scott et al. Nathan Griffith/Corbis Dropouts On average, more than half of those who begin a treatment that is part of a research study do not complete the treatment-they drop out of the study (Kazdin, 1994). The reduction in the number of research participants during a study is called attrition. Suppose, for example, that a group receiving medication (and experiencing its side effects) Researching Abnormality 1 7 7 has more attrition than a group receiving a placebo (and not experiencing any side effects). If you compare those who took the placebo to those who completed the medication treatment, the medication might look very promising. But if you compare the placebo group to all those who started the medication, the medication might not appear more effective than the placebo. Researching Treatments That Target Psychological Factors Many of the research issues that arise with biomedical treatments also arise in research on treatments that target psychological factors. Such relief may be due, at least in part, to common factors, which are helpful aspects of therapy that are shared by virtually all types of psychotherapy. Common factors, and certain patient characteristics-such as being motivated to change (Clarkin & Levy, 2004)-can contribute more to having a positive outcome from therapy than the specific techniques used. This means that Carl Rogers was on to something when he stressed the importance of a therapy relationship that is supportive and warm. If your grief box therapy were effective, it might be because of such common factors and not something unique to your particular method. Specific Factors the existence of common factors creates a challenge for researchers who are interested in determining the benefits of a particular type of treatment or technique. These researchers must design studies in which the effects of common factors are accounted for and the unique benefits of the particular treatment or technique under investigation can be examined. The characteristics that give rise to these unique benefits are known as specific factors. For instance, when researching your grief box therapy, you might want to investigate whether the process of creating the grief box is a specific factor, providing benefit above and beyond the common factors that any therapy provides. Such research has shown that common factors alone may not be sufficient to produce benefits in therapy for some disorders (Elliott, Greenberg, & Lietaer, 2004; Kirschenbaum & Jourdan, 2005; Lambert, 2004); at least for some disorders, specific factors play a key role in treatment. However, for many disorders, including depression, the research results suggest that specific factors may be only as important as (or even less important than) common factors in the treatment of mild or moderate cases (Lambert, 2004). In fact, for some disorders, researchers have found that different types of therapy are about equally beneficial. That is, it could be the manner in which the new therapy was provided that was particularly helpful to patients rather than the technique itself. Specific factors the characteristics of a particular treatment or technique that lead it to have unique benefits, above and beyond those conferred by common factors.

Section 710 of the Communications Act (1996) requires all essential telephones and all telephones manufactured in or imported into the United States to be hearing-aid compatible. The obligation applies to all wireline and cordless telephones and to certain wireless digital telephones. Hearing-aid compatible telephones provide inductive and acoustic connections, allowing individuals with hearing aids and cochlear implants to communicate by telephone. Section 255 of the Communications Act (1996) requires telecommunication service providers and manufacturers to make their services and equipment accessible to and usable by people with disabilities, if these things can be readily achievable. Section 225 of the Communications Act (1996) establishes a nationwide system of telecommunications relay services. The law requires that common carriers make annual contributions based on their revenues to a federally administered fund supporting the provision of these services. Telecommunication relay service providers must connect relay calls initiated by users dialling 7-1-1. The user does not have to remember the toll-free number for every state, but simply dials 7-1-1 and is automatically connected to the default provider in that state (140). The Television Decoder Circuitry Act (1990) requires television receivers with picture screens 13 inches (330 mm) or greater to contain built-in decoder circuitry to display closed captions. The Federal Communications Commission also applies this requirement to computers equipped with television circuitry sold with monitors with viewable pictures of at least 13 inches. The requirement of built-in decoder circuitry applies to digital television sets with a screen measuring 7. The Act also requires closed-captioning services to be available as new video technology is developed. In response, the Organizing Committee claimed it would be excessively costly to make the required improvements. Even so, the Organizing Committee was found culpable by the Human Rights Equal Opportunities Commission and was fined. In Canada a complaint was filed against Air Canada because of its inaccessible ticketing kiosk. Where enforcement mechanisms rely on people with disabilities taking legal action, this can be expensive and time-consuming and require considerable knowledge and confidence on the part of plaintiffs. Research is not available to show how many cases are brought, Chapter 6 Enabling Environments Box 6. This should be done at the same time as, and at no greater cost than, for people who are not disabled. The consortium also works in developing countries on building and improving libraries, training staff, producing software and content in local languages, and creating networks of organizations (141). It also seeks to influence international copyright laws and best practices to further the sharing of materials. It develops tools that can produce usable content, and has intelligent reading systems. In Sri Lanka the Daisy Lanka Foundation is creating 200 local-language and 500 English-language digital talking books, including school curriculum textbooks and university materials. The books, produced by sighted and blind students working in pairs, will be disseminated through schools for the blind and a postal library. This will allow access to a wider range of materials for the blind than currently available in Braille. Local-language talking books will also help those who are illiterate or have low vision. Other approaches, such as financial incentives for the development of accessible technologies and services, might also be fruitful. Further research and information is needed on the types of legislation and other measures that would be most appropriate to reach the various sectors and dimensions of information and communication access across different contexts is needed. Guidelines and standards have generally related to product safety, though ease of use has become more important. Designers and manufacturers argue for voluntary standards, claiming that mandatory guidelines could restrict innovation and competition. However, unless enshrined in legislation, there may be limited compliance with standards.

The change would return nitrate-nitrogen export by the Mississippi River to levels at which the Gulf of Mexico ``dead zone' was small or non-existent. Land-based nutrient pollution has caused algae blooms in the South China Sea, including one in 1998 that killed more than 80 percent of the fish in 100 km2 along the coast of Hong Kong and southern China. These changes affect the habitats of many life forms, since the South China Sea supports substantial populations of fish, invertebrates, marine mammals and seabirds. As an example, since 2002 increasing masses of giant jellyfish reach the Japanese coast year round and severely hamper fishing campaigns. These species originate in the East China Sea, where they are proliferating because of an increasing availability of zooplankton resulting from land-based pollution induced eutrophication and decreasing fish stocks. Fragile coastal marine habitats are threatened, including coral reefs and sea grasses, which are irreplaceable reservoirs of biodiversity; the last refuge of many endangered species. It also contains a high diversity of lobsters, with the second highest endemism count (World Conservation Monitoring Centre, 1998). Land-based pollution (industrialization, urbanization, sewage and agriculture) constitutes an increasing pressure on the coral reef ecosystems. Though eutrophication dramatically impacts locally, sediments from soil erosion, a non-point source pollutant caused by the livestock sector as well as by agriculture at large, are considered a larger threat. Increased rates of sediment input into estuarine and coastal habitats have been observed (East Bay Municipal Utility District, 2001). Field studies have looked at the consequences of terrestrial sediment deposition, water-borne sediment and long-term changes in habitats. They indicate that (similar to the impact in freshwater ecosystems) increasing rates of sediment loading adversely affect the biodiversity and ecological value of estuarine and coastal ecosystems. The shadow appears even larger if we consider that important ecosystem losses date back several centuries, with impacts still occurring today. It is currently difficult to be precise when quantifying livestock-induced biodiversity loss. Losses are the result of a complex web of changes, occurring at different levels, each of which is affected by multiple agents. Similarly in Africa, although pastoralists are responsible for past loss of wildlife through persecution of predators, pastoralism is often seen as a means to conserve the much needed mobility of remaining wildlife. Nevertheless, we have attempted in this chapter to give an idea of the share of responsibility that livestock may carry for various types of loss and threat. Usually, this is based on our calculations in earlier chapters, for example on shares of greenhouse gas emissions, soil erosion or water pollution loads. The processes can also be ranked in a more qualitative manner, according to their relative extent and severity. The large differences in impact between the losses related to extensive grazing and those to intensive livestock are reflected. The overall cumulative loss from extensive systems to date is much higher than that induced by the more intensive systems. This legacy is partly explained by the incomparably higher land requirements of extensive systems, and partly by the fact that intensive systems appeared only a few decades ago. In the past, the most dramatic losses were caused by extensive grazing, in the forms of forest fragmentation/deforestation and alien plant invasions, and by intensive systems in the form of habitat pollution. Conversion of forest to pasture continuous to be an important process of biodiversity loss in Latin America, but this situation is rather atypical. More marginal land will revert back into (semi) natural habitat, and from there, under some circumstances, it may lead to the recovery of biodiversity. Indicationsoftheglobalimpactofanimal productionanditsdistribution International conservation organizations have collected vast amounts of data on the global status of biodiversity over the past decades. The ecoregions threatened by livestock are found across all biomes and all eight biogeographical realms (see Map 29 in Annex 1). The effect of livestock on biodiversity hotspots may indicate where livestock production is having the greatest impact on biodiversity. Conservation International has identified 35 global hotspots, which are characterized both by exceptional levels of plant endemism and by serious levels of habitat loss.