A (2:30)

Right?

C (2:30)

Any type of behavior.

B (2:32)

That's true. And I wish they'd spent more time in these articles talking about ways to make it non unwanted behavior. So wanted behavior, I guess. I. You know what? I really was dreading this. Anytime I see that we're going to read a bunch of articles from Jab, I get a little scared. I'm a little nervous because I'm like, I hope I don't have to do one of those. But ladies and gentlemen, and Folks of the audience. I did, I did. I did pick a JAB article to do the primary note taking on. I was a very brave boy. Well, yeah, I went to a different room. Usually I'm scared, I get cold sweats, but I went to a different room and I went back to old patterns of behavior, which was doing stuff.

A (3:07)

You have two rooms. You have your two rooms.

B (3:10)

I do all my work. And I went to the other one and I was like, I love this topic.

C (3:13)

Now you have straight ABA design right there. We are in context A right now actually. You take your notes in context B and then you come in this context A.

B (3:24)

This is context C. Oh, no, where's context A?

A (3:27)

A's in the sunroom.

B (3:28)

A's the sunroom. B is the recording room.

C (3:31)

Yeah, yeah.

A (3:32)

C is work.

B (3:33)

C is if I. Yeah, C is C would be if I did it, you know, if I got all my work done and I. Or I was picking up the kids late, you know, I do it in my car sometimes. D is a coffee shop. When I have a day off, I'm

C (3:42)

going to read a book in the bed. Like, oh, countdown, 60 seconds asleep.

A (3:47)

Right.

B (3:49)

All right. In any case, today we're going to be talking all about relapse, which means we will also be talking about renewal and resurgence. Not really reacquisition or reinstatement or spontaneous recovery.

C (4:02)

No, not today.

B (4:04)

That's fine. We only have to talk about so many things.

C (4:06)

Yeah, there's really only so much time here, so we'll do a little crash course, I guess you could say. But let me tell you what the articles are that we will be talking about. The first is titled Relapse and Introduction. That was by Timothy Shahan and published in JAB Journal of Experimental Analysis of Behavior 2020. Also a laboratory model for evaluating relapse of Undesirable Caregiver behavior by Mattier, Greer, Fisher, Briggs and Whacker. Those. They could probably be a good country band, I think.

B (4:39)

Oh, I love that. I love that like 20 minute jam solo that they do on that album

C (4:44)

that was also in jab. That's the jab boys in 2018.

B (4:49)

The joke band, jhab boys.

C (4:51)

And also different, different criteria affect prevalence of relapse of behavior targeted for treatment. That was by the Ledsnick, Richie, Muting and Fallagon. That was all that was in Java 2024. And then we may just lightly graze by this last article. Prevalence of relapse of automatically maintained behavior resulting from context changes by muting. Call Richie Pavlov, Bernstein And Lesnik. And that was also in Java 2022.

A (5:24)

We're not going to just glaze over it because it's bad. It's. We're going to glaze over it because we just don't have that kind of time in our.

B (5:31)

A lot of time. That's a really limited amount of time.

C (5:33)

We have a limited time.

B (5:35)

This also, I think, you know, I hate spoiling the ending of, of a show to our listeners. Keep listening though, or don't. Whatever, do what you want. I don't know, what context are you in? You might change your behavior. But it does seem that relapse is one of those phenomena that there are a lot of interesting articles and experiments. We'll talk about some of them now. And at the end you say, wow, I've learned so much about, you know, the umbrella of relapse behaviors. But what I really haven't learned is how to not have relapse occur. Because it doesn't seem that there's any sort of like, ah, this is how you do it. It's real easy. Don't worry about, there's ideas, there's thoughts, there's lines of research which is fun, but it's not like you're going to get to the end of this episode and be like, oh, now I'll do blank. And it solves the renewal or it solves the resurgence problem that, you know, my clients are in. It's sort of like you could do these things. They might help. Maybe not. But if you're the kind of person who hears that and says, great, I can't wait to publish research in Jab. Well, awesome, great. Email us when you're done with that one. We'll do a second part. But if you're like me and you're like, I need to know the answer, well, hey, look over there. At least we had fun along the way.

C (6:51)

Yeah, I mean, this is not uncommon. I think that you can have these entirely theoretical discussions about really minute components of behavior and what you come away from. It is usually, oh goodness, there's so many additional variables that we don't really have either a solid understanding of or a way to exert control over such that we can really make long term predictions about what behavior is going to do under these varying set of conditions. And it's at such like a theoretical level that imagining how that's going to be applied clinically is just a big bridge in between those two. And usually it boils down to we don't necessarily have like the control over all of those extraneous components that may be at play here for us to really know how that's going to shake out in the clinical realm. It doesn't mean it's not an issue because it. As our articles talk about, like, they. They're using real world examples.

B (7:55)

Yeah. I mean, you could stokes and bear your way to improve the generalization of a skill and sort of hope that takes care of it.

C (8:03)

I mean, that article, too, it's actually like combining a bunch of different things. When we talk about generalization, we really mean several different things. And that article, like, kind of mushes them all together as well. Yeah.

B (8:16)

Well, let's get started with an introduction, which Dr. Shahan, I did like your article. You summed up everything that was in the journal that we didn't read. But if you're going to call something an introduction, I need you to very clearly define your terms, not sort of like, bring them up as they come through your paper. I was a little, well, grumpy at you. And then some of the other papers did a great job defining what all of these. It's like relapse. It's all these things. What are these things? Don't worry about it. We'll talk about it later. It's like, just tell me now.

C (8:43)

Don't worry about it.

B (8:44)

It wasn't like, here's my awesome thoughts on relapse. I get it. Maybe you expect that I know all this stuff already. It's an introduction. Assume the person's reading. It's like, good. I need an introduction into this topic area and go real slow.

C (8:57)

Well, the introduction to the issue, I

A (9:00)

think, is not even introduction to. Because you think that people are going to. They'll. They'll be excited. They might not know. They might know.

C (9:06)

If you cracked open jab just for some light reading, then you're probably ready.

B (9:12)

That's. It's like the first rule of jab is we don't talk about the definitions

C (9:16)

of what you have. Quite possibly. No.

B (9:21)

No shots fired on basic researchers.

C (9:23)

What this is a special issue is my understanding. Right. On relapse in jab. And so it's an introduction to the. The issue, but not.

B (9:31)

Then it should be called relapse. An introduction to our special issue. All right. We're gonna. We're gonna talk about changes in context a lot. And they change our behavior in ways that we can't always predict.

C (9:42)

Okay.

B (9:43)

Well, apparently Dr. Shan has made me engage in aggressive verbal behavior.

C (9:47)

I mean, he's a nice, nice man.

B (9:49)

I know, I know. And he Sums up the articles very well. Like, there's a lot of great content. I'm. I'm teasing him a little. Just teasing them a little. It's a good article. I just want. I want like a table. There's so many R terms. Give me a table.

C (10:03)

Yes, there are quite a few R terms. It's funny that almost all.

A (10:06)

Isn't it funny that almost all of the terms under relapse start with an R?

B (10:11)

Yeah. Except for spontaneous recovery. Relapse.

A (10:16)

Yeah.

C (10:19)

So he starts us off with this quote that's like attributed to Mark Twain, but then he says, I don't really know if it is Mark Twain, but it's like a great quote which is, I've successfully quit smoking. I've done it many times.

A (10:32)

I've successfully quit eating Cadbury cream eggs every day. Many times.

C (10:36)

Many times. Right.

A (10:37)

And.

C (10:38)

And so he, he uses that to highlight that the re. Reoccurrence. Right. Of behavior, after you sort of thought that you dealt with it, it rears its ugly head again. Right. Is a long term problem, not just in our field, but in life in general.

B (10:55)

That's my field. Where we want new things to happen, new behaviors to occur, and then great, they are occurring. Let's hope they occur forever and ever. If you could find out how to make that happen, you would have the billion dollar idea.

C (11:09)

Yeah. And this is a little bit like the opposite. Like you were saying, Stokes and bears. Like the opposite of like train and hope.

B (11:14)

Right.

C (11:14)

Where we're like, we fixed that problem and we're done. We wash our hands of it and we will never expect to see that again. Well, that is a little bit shortsighted. Just in the same way that train and hope isn't really preparing someone for the future. If we were to never anticipate that behavior might return under some set of conditions, that would also be shortsighted. So in fact, there are many times and ways in which this can happen. And we call it by many names. As we have already alluded to. The umbrella term is relapse here. And he. He's sort of like hems and haws about, should we call it relapse? Because that's something that. It's a lay term, but it actually is useful. But it's not only unwanted behavior, it can also be wanted behavior that returns. So eventually he was like, okay, the umbrella term of relapse is fine. But more, there are more specific terms and definitions that relate to, you know, particular, particular contextual reoccurrences of behavior. And we have Studies in this episode, no, in this issue that are going to address several of those. And so if, you know, the term resurgence that falls underneath this umbrella of relapse, renewal, reinstatement, reacquisition, and spontaneous recovery all have a certain set of conditions that, you know, precede them. And then when you see behavior pop back up under that set of conditions, it takes on that title. So we'll go over a few of those as we go over some of these studies. So, you know, they note here that there are just still lots of questions that remain about learning and extinction and suppression of responding under varying conditions. Do we really have an understanding of what extinction is doing when it's in place versus when we see, you know, other forms of behavior reduction strategies that are in place? It's likely that those have. Are decreasing or weakening responses under, you know, using different principles or properties of behavior. And therefore we might expect to see varying likeliness of behavior reoccurring later, depending on what that initial context was. The state and condition and context under which behavior is occurring as well can make a difference. He talks about is it the case where we see what he calls inhibitory learning? Right? So not, you know, no longer doing something that's really contextually dependent and that that may change based on the rate of responding and. Or the rate of reinforcement that's available there. And the summary of that is, gosh, there's just so many different variables that we don't necessarily know what all may be at play at any given time. So in this article, in this issue, they're going to go through several different looks at relapse under a variety of those names that I just mentioned. He notes that organisms seem to learn in experiments when there are fewer training trials per session leading to faster acquisition. But more training trials can also generate higher levels of responding. And then those higher levels of responding make greater spans of training, which could generate spontaneous recovery over time. So when a spontaneous recovery you see sort of re. Reemergence down the road of it previously extinguished behavior. So that is something to take into consideration. And then he brings up the question of delivery of the primary reinforcer. So is it possible that responding under a certain set of conditions after the behavior's been extinguished, right. When you then again see a cue that had been associated with a primary reinforcer in the past that has since been extinguished, when that is present, is more likely that you then see behavior reoccur? Is it possible that there's an increase in motivation for the primary reinforcer when you once Again, see that cue that's present. And if that's the case, then that might be why under that set of conditions, we see a resurgence of responding. And then some of the research in this area is based or has been done with addiction. Right. And so he talks again about just the highly reinforcing value of addictive substances and how there may be sort of a limited window in which that motivation is exceptionally strong. And once you're past that sort of temporally associated window, then behavior may be more likely to remain at low levels. So there's both contextual components here and temporal components that may increase the likelihood of behavior reoccurring.

A (16:02)

Right. I want to just take an aside for a moment because I know that many of our students have a hard time distinguishing between spontaneous recovery and resurgence. And one way that I found was really useless. Useless.

B (16:16)

Good one, Jackie. The one that will help us.

A (16:19)

Well, one that I think is useless. One thing I found is.

B (16:22)

Had the show with this is when

A (16:25)

you think about spontaneous recovery, it's usually one behavior, right. A behavior has lost its contingency with the reinforcer, and then that comes back with resurgence, there's always two or more behaviors. Right. And so that's been really helpful for me in teaching. The difference between the two is that you look at your scenario. And if one behavior decreases and then comes back, then you know that spontaneous recovery. And if one behavior extinguishes and then you teach another behavior, and then that behavior extinguishes and the first behavior comes back. Now, there's two behaviors, you know, that's resurgence. So just a little tip, Jackie.

B (17:04)

What's an example of one big. Because I'm thinking of, like. Oh, like sib decreases on its own.

A (17:09)

Yeah. So. No, no, not on its own. Let's imagine that you have problem behavior maintained by attention. Right. They give little wax when they want your attention. You put that on extinction, and you reinforce an appropriate behavior of tapping. Right? So eventually the taps, the. The wax go away. The tapping emerges. But now you want to acquire a more. You want them to acquire a more complex response. So now instead of tapping, they have to say, excuse me. Right. So you're going to be putting tapping on extinction. You might not. Right. But let's imagine you are. You're putting tapping on extinction, and now you're only accepting. Excuse me. You're likely to see the resurgence of the wax because the previously reinforced response is now on extinction. So that's that. You're going to see the upbeat of the wax now. Right?

B (17:56)

Yeah, that's the resurgence. That one I get.

A (17:58)

Oh.

B (17:59)

With the spontaneous recovery, it's giving non contingent attention and the wax are going down.

A (18:07)

Wax. So let's say the wax you are. Now, if the wax are maintained by attention, you no longer are providing attention contingent on whack. Little wax, Right.

B (18:17)

Yep.

A (18:17)

Whacking. That just sounds, you know, you chose it.

B (18:21)

You got to go to the end of it.

C (18:22)

Now, let's say I walked in a room, right? The door got locked somehow, right? You were the opening. The door is now on extinction. So you're going to try a ton of stuff. You're going to bang on the door, you're going to yell, right? You're going to like twist the doorknob, you're going to pull on the door and then that all of those responses may be extinguished for a time and you're going to give up and you're going to go sit against the wall, right? And you're like, I'm trapped in here. Then seemingly out of nowhere, right. Suddenly you're going to jump back up, you're going to run back over, you're going to try it all over again.

B (18:53)

That's spontaneous.

A (18:54)

Yeah, that's spontaneous. I also like to think about it when you break up with someone and you're texting them nonstop and then they don't respond to you, and then you're like, fine, I'm never going to text you again. But two days go by and you're like, I wonder how they're doing.

B (19:08)

Right?

A (19:09)

That spontaneous recovery.

B (19:11)

Gotcha. Okay. Okay. So. So it's, it's more. So anything you're using, like FCT or some sort of a dra is probably when you see a return of the problem behaviors, probably resurgence.

C (19:20)

Because this is just.

B (19:21)

Yeah, because you have to teach, you know, increase the rate of some other behavior. Gotcha. Okay. That was spontaneous recovery. Okay, I appreciate that. Spontaneous recovery is one that I've always sort of struggled with. Like, how is that not kind of the same?

A (19:32)

You've done it. Everyone has done it. Right. I know that. I'm like, are you mad at me? Do you miss me?

C (19:39)

And then you send like a funny meme. Oh, yeah, you're talking about.

B (19:42)

Everyone mixes those two up. But no, Jackie, you're talking about your dating life.

A (19:45)

Okay, My dating life. A long time ago, before I got married, I was, I loved, I was. I don't know. I have some behavior that has. Is very resistant to extinction.

B (19:57)

And at any point, Jackie's behavior could spontaneously recover. Be careful. Stay away.

A (20:02)

I have so many good Examples in my life when I look back and I'm like, oh, that behavior was extinguished. And then look at spontaneous recovery again and again and again.

B (20:12)

All right, well, that's our next bonus episode. It's going to be Jackie's relapse stories. All right, so. So we know a little bit about some of the possible kind of, you know, relevant variables when it comes to resurgence, but there's more.

C (20:25)

Oh, yeah, I can keep going here.

B (20:27)

So do a couple. I know there's a. There's at least one. I want to. I want to go.

C (20:30)

Yeah. Do you want me to talk about this resurgence as choice theory here or down below? Okay. So Shahan also talks about resurgence as choice theory. So this is like an extension of the generalized matching law, which states that an increase in the duration of treatment with extinction plus some alternative reinforcement tends to produce small, reliable decreases in subsequent occurrences of resurgence. And so therefore cycling on and off between adding in the additional reinforcer should ultimately reduce resurgence on a whole versus just doing solely extinction. So there is a little piece of like, here's a recommendation type of type of thing.

B (21:14)

So don't just go fr1, fr2, fr3. Sometimes you want to go fr0.

C (21:20)

And then he also talks about extinction versus omission training, meaning basically, are you reinforcing in the absence of the. Of responding? Right. And that those two likely are sort of operating under different behavioral mechanisms, and therefore you could see a difference in reoccurrence of behavior. So here they note that my behavior that is eliminated via omission training is likely more susceptible to renewal and less susceptible to a reinstatement that has been induced by the reinforcer delivery. So if you're adding in non contingent reinforcement, then while you're trying to decrease the behavior, then the recovery period following the elimination, you may see more. Did I say that right or did I say that backwards?

B (22:12)

I believe you got it.

C (22:13)

Okay.

B (22:14)

And at the end of the day, some of it might not matter that much because a lot of these are rat studies.

C (22:18)

Yes.

B (22:19)

So these are like general phenomenon that we want to, like, take into account think about. But a lot of the research is done with rats, meaning it may or may not look at all like that. With humans, it probably looks similar. Probably some of the, you know, similarities. All organisms, however, you know, it's not a one to one correspondence.

C (22:36)

Yeah. And then the. He talks about renewal. So seeing behavior reoccur in a different context, and it's very likely that these varied contexts can produce important changes in behavior, which again, I feel like Makes sense. Right. So he talks about the ABA arrangement. It's not aba. Like we say aba.

B (22:54)

That took me every time I kept

C (22:56)

going back and looking.

B (22:57)

They do this in ABA only not in basic research. What?

C (23:00)

Yeah, but he means like context A, context B, and then going back to context A, you, you may be likely to see behavior reemerge in those settings. And so he says if alternating between having one context associated with reinforcement and, and one with extinction during the treatment can be a strategy to reduce the renewal of the whatever the target behavior was that you're looking to decrease when you move into the novel context. Which you know, I think makes sense. It's just you're hoping to sort of reduce that context dependent responding. Right. So it's kind of like the idea of like training loosely a little bit. Right. If we talked about generalization. So again, that is sort of a tip piece I think you could take away from this is don't just stick to one setting or you might be more likely to get context dependent responding and therefore reemergence of behavior when you return to the original, original context. Yes, target behaviors appear to be more disrupted in non trained contexts when you go back and then when you go back to training. So that happens more with a DRA than during extinction too. So again, there's like a distinction there, I believe is what he's saying here. And resurgence therefore may be lower when there is an alternative behavior they can continue to be paired with, with a stimulus.

B (24:25)

Okay, there's one, there's, there's one finding. And again, we didn't look at the, we just look into the introduction here because there's just so much like, hey, here's an idea, here's another one. But one related to use of things like ACT strategies to alter the functions of aversive stimuli, which is going to sort of be looking at your ability to sort of accept and engage in sort of like mindfulness practices doing. I don't think that was a rat study. The rats wouldn't tell us they were really non compliant about sharing their thoughts and feelings. No, but in terms of being able to remain in the present moment when you are engaged with aversive stimuli and orient towards other sources of reinforcement. So that's one of the reasons I'll often, you know, as part of an ACT strategy, kind of have you focus on staying in the present moment because it allows you to look for other sources of reinforcement. So when we're talking about relapse saying like drug, you know, drug addiction, relapse, if you're able to do that you have a craving or you have a thought about, I need to have, I need to get, you know, drug of choice. That this might help you sort of like ride that urge. Surf is a term that's often used. And be able to sort of be aware that you're having that thought, that it's a thought that it's not something you have to do again, unless you were in physical withdrawal. And that you could look for other sources of reinforcement even though the environment has now changed, that might be cueing a relapse behavior. So access to drugs being available as a potential strategy. They don't go into much detail there.

A (25:52)

But again, I think that's fascinating.

B (25:54)

That sounds interesting. I'd like to see more. That might be a useful line of research to help. But again, you're only going to be able to use those strategies with individuals who have kind of complex vocal verbal repertoires. So that won't be a fix for every situation of relapse. And it may not even be a fix for that many situations where relapse occurs.

C (26:13)

And yeah, and then he also mentions, like, if you're doing extinction with a DRA component, then just changing the length of that session to be longer or shorter isn't necessarily going to ultimately affect the amount of resurgence that you see. And this, then this sort of gets into like, overall, like modeling of likelihood of behavior occurring. And then you. You start to have different models that are going to suggest different things. Right? So the resurgence of choice model versus the behavior momentum model are going to make different predictions about the likelihood of behavior reoccurring once you are out of that phase. And so that is deeper than they went in this little intro. But certainly some of the other articles in that issue probably got into some of those things. And then they talked a little bit about cues that could be present if you're, you know, trying to indicate that this is extinction versus this is reinforcement in order to. To decrease the likelihood of relapse occurring in the future. So could you have like an S delta picture or symbol that represents the extinction condition? Does. Does that potentially reduce resurgence versus when you don't have any cue present? And the argument there would be that more discriminative stimuli could be included in order to help signal when reinforcement is and is not available, which may decrease the likelihood of resurgence occurring in the future. Okay, and that was just the intro there. But again, he's like trying to introduce like, these varied topics in the, in the field so that other articles can then go more in depth. And then. So we have one. What do we have here? One article that's going to talk about resurgence. Right. Jackie?

A (28:00)

My article talks about renewal and resurgence and how, okay, you can look at it and how you can characterize it when you're looking at data to figure out if it actually happened or not. And what's a, what's a better criteria? So they looked at both renewal and resurgence.

C (28:16)

Gotcha.

B (28:16)

Yeah. Whereas the focus of the material et al article is more, more renewal because it's all about context.

C (28:23)

All right. And the muting one is more about renewal. So we kind of covered the gamut there. But these articles will get more in detail about what those individual processes look like.

B (28:33)

Yeah. Well, let's take a break. There's so much to talk about in relapse. We're not going to talk about it all, but we try to give you a sampler platter of some of the areas of research. We take a break. When we come back, we're going to focus a little bit more specifically on sort of the actionable steps that may or may not support an avoidance of relapse. We'll be right back. Hi.

A (29:05)

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C (29:10)

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B (30:23)

And we are back talking all about relapse. But before we do that, I want to remind our listeners that ABA insidetrack is ACE and Kwaba approved. All you need to do is listen to our show, go to abainsidetrack.com or click the link in your podcast player to go directly to this episode's Link. There you will find links to all of the articles that we are discussing as well as transcript of the show, some other fun goodies and a place to get ces. You're going to need to remember a Some of the stuff we talked about is according to new guidelines where there is a quiz that goes along with our episode. So pay close attention. And two code words. I'll give you the first one. Now pay attention to this one. You might want to write it down. And it's sugar. S U G A R Sugar, sugar, honey, honey,

C (31:13)

are you my candy girl?

B (31:14)

Oh, what an introvert. Yay.

A (31:18)

I know it. But I knew it.

B (31:19)

You knew it. It's on the tip of your tongue. Weak stimulus control on the tip of your tongue. Sugar, sugar. All right, so when we last left off, we talked about all the relapse ideas that seem to exist. But let's focus in on a few of them, shall we? I think one of them that really comes out in this Mater et al article is the idea that many of us see, which is that, hey, teaching skills sometimes is pretty straightforward. Especially when we use such awesome procedures as functional communication training. Everybody loves it. Or general DRA type procedures. Right? I want to teach an alternative behavior that accesses the same function as the disruptive or dangerous behavior that the client engages in. Now, you don't need to engage in that silly old dangerous behavior because you have this great new functional communication or I reinforce some other behavior. Right? And isn't that great? We're all happy about that. Everyone, high fives, child goes home. And then what happens at home? Why renewal. Of course, you might have said relapse. You'd be right. But I'm technically writer, which is the best kind of right there is. Because renewal, unlike resurgence, where there's a some, some behavior, is now on extinction and resulting in a return of a behavior that had been extinguished. Renewal is a return of a behavior that had been extinguished due to a change in context. So that's the difference between those two terms. I thought it was the Windows by Anderson, but it is not. It is something a little bit different here. It's a type of relapse. So what happens local reference when we, I, I, that's, I think that's a, it's a. Maybe it's not a global brand, I don't know.

C (33:01)

So I'm gonna say Anderson. It's like a, it's got like a New England quality. Anderson Windows and doors and you sound

B (33:07)

like you're from New York now, Anderson. All right, so one of the challenges again is you see renewal. So child goes home or client goes home. Maybe parents attempt to engage in the treatment, maybe they're doing a bang up job. But eventually, no matter how good they are at following the treatment, one of two things is going to happen. One, because of other things occurring in their environment, they will not be able to deliver the reinforcer at the rate it needs to be delivered to maintain the new functional communication, you know, or differentially reinforced behavior. Or they just can't give it no matter what because it's a communication for something that just isn't available at the time. So at some point this new behavior is going to be put on extinction. And that's when you may see renewal. You may see that relapse of the dangerous behavior that was originally treated. That unlike what you might have think of, okay, how do we make the clinicians do a better job? How do we make the clients do a better job? This article is all about what does this mean for the caregivers or parents who are implementing this treatment. Caregiver adherence we all know is very important because even when the treatment is adhered to nearly 100% of the time, we know it might not be adhered to 100% of the time due to life occurring changes in context that are uncontrollable. So it makes it even worse if the treatment is even being adhered to very well to begin with. Actually maybe it doesn't make any difference at all because they would just be doing the removal of reinforcement or the over thinning of the schedule already. So why does this happen? Well, of course, you know, what you'd expect to see is kind of that general kind of a negative reinforcement. The child is re engaging the, the destructive behavior has renewed. So the parent might engage in their own renewal. Actually no, this would be their resurgence, the resurgent behavior. Thank you, Jack. Jack, you almost got me, but I, I jumped ahead of it. So the parents will now have resurgent behavior in which they'll go back to what they used to do, which might be, you know, yell at their child, cut it out or stop that or you're in timeout or whatever they do, which again will.

C (35:10)

Or just give them the iPad or

B (35:12)

they'll just give them the item. Right, that's what parents do that often. So again, the child behavior will be reinforced. The parents resurgent behavior will also be reinforced in the form of the disruptive dangerous behavior stopping, you know, slowly ceasing and you get back in the same cycle that probably led the family to Seek out treatment in the first place. So while the goal is to teach caregivers how to use FCT and how to reinforce specific responses, usually using some form of bst. Right. Just doing this may not result in the long term behavior change that we would. Everyone would like to see. If you don't, you use any sort of skill generalization with parents because you're usually probably training them either in their home or in the clinic. The home would be better. But you may be training them in the clinic and never in the home, depending on, you know, the, the services you're able to provide without that training in a novel context directly, you are going to see some amount of renewal. It could also be the fact that the child will eventually engage in some sort of renewal of problem behavior, leaving the parents to engage in research, you know, have their behavior resurge just due to, again, life, life factors, some, you know, inadvertent extinction. Because eventually you're not going to get the thing that you ask for that just happens. There's things you could probably do about that. But the goal here was to say, let's do an experimental evaluation of caregiver treatment adherence specifically in an FCT based intervention. And we'll do a little lab model because it's jab and we'll sort of see how we can replace undesirable caregiver behavior in the typical outpatient model. So they're pretty much like, let's just study this phenomenon in terms of the way it usually does, which is let's train the parents to do something. And then when the new behavior that we've taught the quote unquote client, because they use confederates in this study, when that behavior starts to is on extinction and the resurgence occurs, what happens to the parents or in this case, renewal. So we had four caregivers participating in the study with the first author. I love that the first author said, I'm going to be a confederate. So they're running around having tantrum behavior using fct. They're doing all this work. And they wrote the paper too.

A (37:20)

They were so busy.

B (37:21)

They were very busy. Probably they did them at different times. But the first author is a confederate in the three phases of the study. In one and three, we had a baseline and a treatment adherence challenge, which basically boils down to guess what? Your treatment ain't gonna work. What do you do now? And then they had a phase two, which was just teaching fct and that was in the clinic setting. The other two, the treatment adherence challenge at the baseline was a Little home like context where they got a little couch and they got a little vase, they got some decorations up on the wall so as close as a homey environment as you can make in the clinic itself. And what they were measuring is the dependent variable were the undesirable caregiver behaviors. So the caregiver providing some programmed reinforcer for the, you know, unsafe or the dangerous behavior, the destructive behavior, they referred to it, which would either be attention or for one of the participants, was an edible item. So destructive behavior led to reinforcement. That would be an undesirable caregiver behavior. Because what we want to see is the caregivers engaging in only delivering reinforcement following the functional communication that had been trained. Now, how did the confederate know what to do? Well, they had a little audio track that they were listening to in an earbud that pretty much told them as they went through these little three minute sessions, time for fct, time for destructive behavior. They also had a vocalization, a negative vocalization audio track playing in the background. So that would just like play at various times in the little three minutes. Because again, there were some pauses in the confederate behavior scripts that they were listening to. So they wanted to make sure that there was always some, like, little chance that there was some sort of caregiver behavior that the parents needed to respond to. They didn't want, they didn't want to put in any sort of adventitious reinforcement. They also use audio of their actual child. So they tried to make it as real as possible, which is why these sessions were about three minutes long, because they didn't want to have everybody quit and drop out of their study in these like 20 minute sessions of screaming children in which the parents could do nothing but curl up in a ball. So that wasn't the plan. So there's small, small sessions here, so.

C (39:15)

And very punishing.

B (39:17)

Oh, yeah, real rough. The goal was again to get a baseline, then to do a training, and then to do this caregiver treatment adherence phase where no matter what they did in the home environment, it was pretty much the equivalent of your child's inconsolable. If they make FCT and you deliver reinforcement doesn't stop the destructive behavior for happening. And then the destructive behavior just happens on the schedule.

A (39:38)

I like, I like how you said make FCT. If they make FCT, because that just make it FCT.

B (39:44)

You got to make those FCTs how you get, you get by the world. They also did a little extra staggering. So each participant did phase two, which was the functional communication training Phase to see if you've had a longer history in which there was reinforcement for the confederate destructive behavior, meaning you, sorry, you didn't start fct. I should say phase one was the stag woods. You didn't get to start. So you were sort of stuck in that initial baseline for longer periods of time, meaning longer histories, where you were like, please, you know, confederate, stop your destructive behavior. Whether that would result in higher level of relapse when the whole thing was over in terms of those undesirable caregiver behaviors. So do they go back to their old ways if they've been doing it for longer? Was kind of what they were looking at here in, you know, nine minutes total. A little bit longer than that for the training. So baseline, they just were like, here you go. Here's a confederate. They're going to do stuff. The confederate would engage in their scripted destructive behavior. There'd be continuous negative vocalization track playing. They'd go for kind of the max number of destructive responses, which was 90 per session.

A (40:42)

That's a lot.

B (40:43)

Yeah. And the caregiver, if the caregiver, if they did engage in here, here's attention here, here's the food item. After destructive behavior, it would terminate it and pause the vocalization track for 20 seconds. So pretty much doing, I don't say the wrong behavior, but doing the, you know, undesirable behavior would result in a removal of, you know, a cessation.

A (41:02)

I bet the confederate got sweaty.

B (41:05)

Oh, probably they're running around listening to Bluetooth earphones. I gotta yell at you or hit you right? Then they did behavior skills training on FCT. Only took 10 minutes. Talked about why. Here's what it looks like. Let's do some role play till you're 100% accurate for six trials of using FCT. Boom. Done. Now they move to FCT, which is pretty much the exact same as baseline, but they were in a clinic setting, and they said, you should use this new FCT that you learned how to do. And in the first session, they had 45 FCRs and 45 destructive responses. A confederate would make. So again, after an fcr, would the participants say, yeah, here's your attention, or, here's your edible. Thank you so much for talking. And then after destructive behavior, would they be like, I'm not giving you anything because that's not what I'm supposed to do? Pretty much what they were looking for here. And again, FCR correctly responding to FCR would result in the termination of destructive behavior in the vocalizations for 20 seconds. They also decrease the volume of vocalization to try to capture. This is what it'll feel like when you do this correctly in the future. Everything will just get better and better and better. So kind of reinforcing their treatment adherence subtly in that way. Then finally, phase three. Let's go back to that homelike setting that's in our clinic. We got some pretty pictures on the wall, and guess what? No matter what you do, nothing is going to work. There is no change in confederate behavior.

A (42:26)

That's how I feel about my life.

B (42:27)

I'm gonna ask for things, and you're gonna give it to me, and I'm still gonna have loud noises. I'm gonna have disruptive behavior, and you're gonna ignore me, and there's still gonna be loud noises. There's nothing you can do. They did only three sessions of this, lasting for three minutes because they felt it was just too horrible for their participants, which is true. That would be horrible.

C (42:45)

And, yeah, you just get.

B (42:47)

Ah. So what did they find? Well, unsurprisingly, in baseline, there were high rates of undesirable caregiver behavior. Here, here. Anything to stop this. Just this destructive behavior. Right. But after training, huge plummet down to near zero in terms of undesirable caregiver behavior. Nice improvements in the use of functional communication training. Then, in the adherence challenges, three of four caregivers engaged back in those undesirable behaviors. So relapse occurred in these cases. This could be renewal and resurgence, I guess, because they're in a different context, and they're also. All Their new behavior has been put on extinction through the. Through the confederate behavior. One person just went through it. They were a champ. They just kept doing it. They made it through. I hope they got a certificate when this was all over or a gift card or something. Everybody else, the other three had at least some rate of desirable behavior. And the caregivers with the highest levels of relapse. Longest histories of reinforcement for undesirable behaviors at the beginning. There you go. And they were mostly commission errors. So because you couldn't have an omission error, and they do say, like, you couldn't really have an omission error unless you were the one participant with the edible. Because there's nothing.

C (43:55)

Right.

B (43:56)

You know?

C (43:56)

Can I tell you something?

B (43:57)

You can.

C (43:58)

As you're talking about this, I was like, this reminds me a lot of some research that Rachel Thompson was doing a long time ago where they had the baby. Like a baby doll that would keep crying. Right?

A (44:10)

Remember this?

C (44:11)

Remember that. And. And they would, you know, teach them, like, how to respond to the baby. But then they would have another session where the baby would just keep crying, so it's like a colicky baby. And they looked to see, like, what would the parents do? Or it was the. I mean, whoever was in the study. And so I was like, I wonder what happened there, because I hadn't followed up on it. And what do you know, the title of that article, it was published in Java in 2009 is resurgence of infant Caregiving Responses. It absolutely was Resurgence that they were looking at. And the first author on that is Bruk, if anyone wants to look that one up.

B (44:42)

Nice.

C (44:43)

Cool.

A (44:44)

Yeah.

C (44:45)

So that one came full circle for them.

A (44:46)

Yeah.

B (44:48)

So what we learn? Well, if you leave a clinical context as expected, you may see renewal of undesirable caregiver behavior. You also may see that for the child as well. But they were specifically looking at the caregivers in this study. And if you're not using FCT correctly, you're likely to see a relapse, which. Surprise, surprise. So maybe we want to think of our resurgence evaluations as an evaluation of how susceptible that recently treated behavior is to breakdown in treatment adherence. So we probably want to be thinking about how do we prepare for that with caregivers in terms of focusing on what are the commission errors that may occur, what should they do instead? They have some ideas about they could do this study again and do it a little bit better in the future. But another thing that they bring up that I think is good is really, parents who are in situations or caregivers in situations where they're waiting a long time for services and treatment are most at risk of having some amount of relapse of their own undesirable patterns of behavior after the change occurs, because they've had that longer history of reinforcement of undesirable behaviors. Seemingly that might not be exactly what's going on, but that's potentially what's going on there. So again, we want to be really aware of these changes in context. So if you're not training in different contexts, maybe you should. There's other things we can do about relapse and resurgence on the. On the client side. But on the caregiver side, they really need to be trained in multiple contexts, and we probably need to have some treatment adherence challenges for them to practice so that they are aware that there will be times when all of this doesn't work, but they still could engage in. Maybe that's where that act mindfulness Comes in of like, oh my God, there's so much screaming and yelling. But you know what? My value is being a great parent. So I'm going to, you know, huh. Take a deep breath and I'm just gonna keep doing what I was trained to do. Maybe add that in. Who knows? They do warn that if you change context and then you don't prepare them for a dis. For reinforcement for their alternate behavior actually being removed or being put on extinction, be careful because you may get super resurgence. It's renewal. Renewal plus resurgence equals super resurgence, it seems so. There you go.

C (46:48)

Can I just say that the mu thing et al study because I don't. I don't think we're going to have time to review it in total. But it also looked at renewal across a variety of contexts. And the piece I wanted people to hear regarding that is that they looked at when. When it was the. A different person, that was the context change and different setting, that was the context change and they saw more renewal when it was a person there was the context change than the setting. So that is the.

A (47:16)

Mine talks about that too.

C (47:18)

Oh, great.

A (47:19)

Yeah.

C (47:19)

I'm gonna turn it over to you then.

B (47:20)

But that was specifically in automatically maintained behavior.

C (47:23)

Yes, I'm sorry it was specific to that. But that is the. I felt like it fit in with your article there, so I thought I just. We glided right over it. Right.

B (47:33)

Train across context. There's a reason they do it in all the studies. It's not just for better experimental control. You actually need to do these things.

C (47:43)

All right. What about you, Jax?

A (47:45)

So mine is a fairly interesting article. It is not looking at current data. It's looking at data that's already been collected specifically on challenging behavior and the effectiveness of long term functional communication training. Right. And they were looking at renewal and relapse. And they suggested that recent studies, like you said, Rob, renewal may happen in as much as 4, 40% of context changes and from 0 to like 60% if there's a. What they called an implementation agent change. So like if it's a new paraprofessional or a caregiver's running it, that you're more likely to see renewal and resurgence there. And so they wanted to look at if we are actually when we're looking at resurgence renewal, if we're actually being too conservative in our measurements. Because what. What researchers clinic would do now when they're looking at that is they compare the maximum response rate from the five sessions preceding the treatment. Right. So they call that the pre change rate. And then they look at the response rate following the treatment. Right. Whatever challenge you have, like did you change context? Did you change caregivers? And then they look at the post change rate there to see if the change rate is higher than what happened before treatment. This is with problem behavior. And if it is, then they say, oh yes, look, relapse has occurred. Right. And they created this based on that awesome Lerman and alt study in 93 that looked to see if an extinction burst occurred. But they were like, I think this is actually fairly conservative because a lot of things can happen during those five sessions before treatment. Right? Like you could be transitioning, there could be different variables at play. And so it, it just. They said that it might also not detect relapse when it's actually occurring. So they wanted to shorten the number of sessions before treatment to a mean of two to see if we are being too conservative in saying relapse doesn't occur when it actually had occurred. So that's all they do. They took data from previous studies that the one that looked at the mean criteria or the mean of five and they reanalyzed this with the new criteria of the mean of two and then compared it to the previously taken data. Right. And it's important to note that these were actual data from participants who were receiving services in inpatient and outpatient settings. So it wasn't. They were just receiving services in the world. And then the researchers were pulling that data up and looking to see if resurgence or relapse was there when these context changed happen. So that's kind of neat, right?

C (50:31)

Yeah, I just thought it right into the big resurgence computer. It's like

A (50:37)

that's what it sounds like. And so they looked about in two changes, right. They looked at the change in treatment settings and they also looked at the change in intervention change agent, like you said. Right. And we all know what setting changes could look like and who intervention changes could look like. Right. And so for resurgence, when they were looking at resurgence or for renewal specifically, they were looking at the data across the last five data points in pre change and the first three in the poise change or in the post change or the maximum post change, and they were looking to see if that exceeded. So they were looking say I have a number here, I have a number here, a number post the challenge, right. Post the change in context and a number pre the change. And I'm looking to see which is different. Right. And so they noticed that when they looked back at the data, they found that when they Use that mean criteria of 2 instead of 5, they had an almost 10% change in the estimates, meaning more studies or more behavior was relapsing than what they had previously stopped. And when, when they had previously thought of and when they looked at context change, there was 8% change. So there was more relapse noted when we used the mean, the mean criteria of 2 instead of the 5. And when they looked at the intervention agent change, they also saw an 8, 8% change. So it's pretty neat that they were like when we looked at this data with this very conservative measurement that everyone has used for extinction bursts, we didn't count that behavior that was happening as relapse. But when you're more, when you fine grain it down, actually reop was occurring because when you look at the graph, the post change data was always higher than the pre change data. When you're looking at that mean of two. So what this means for practitioners, because this is like a kind of.

C (52:36)

That's my question.

B (52:39)

Wow, thanks.

A (52:41)

Yes.

C (52:41)

Does it mean you need to intervene sooner? Right. Or do things like kind of shake themselves out or like what does it mean?

A (52:47)

Well, what they're saying is that when you are looking to see if relapse occurred or not, right. If you're going back on data, you should probably do both estimates and see what happens and then dig deeper into that data to figure out what you need to do. Right. So they said that in this, in these like data that were already there for them, they didn't look at stability before relapse. So they didn't see if the behavior was like very stable and then there was a change in context and then relapse occurred. So they said that future research should really look at that in both clinical applications and retrospective studies, which this one was. And they said this, we also might want to look out longer past those five because we know that there could be delayed discrimination of a stimulus change, right? Like someone's like, oh, the context change. I don't realize it yet. Yet, Yet. Oh my gosh, it's changed. We've all been there, right? And then, yeah, renewal would happen or resurgence might happen. And they also recommended that they just looked at the return of problem behavior, not around the maintenance of functional communication responses. So maybe that also extinguished which led to renewal of the problem behavior. So they said when they're, when you are trying to calculate whether relapse occurs, you shouldn't be as conservative if you're worried that it has. And you should really dig deep and look at both the problem behavior occurring as well as the functional communication response. Yeah, that's what it was. It was a very experimental article.

C (54:22)

Right. But I would think the sooner that you recognize that something may be awry, then the sooner that you can go in and retrain or readdress, maybe put in some more supports and see that behavior sort of drop back down. That's the idea here.

A (54:39)

Yes, absolutely.

C (54:40)

Don't delay, don't wait. Yeah. Call now.

B (54:44)

All right, well, I think this is a good time to bring us into the dissemination station. So. So when we're talking about relapse, I think we're sort of going to look at it from two ways. Number one, planning for relapse, resurgence, renewal, whichever one it is, financial recovery, whatever it is, that it's probably going to happen if you don't do something about it.

A (55:07)

Yes.

B (55:08)

Number two is how do you track how that might be happening so you can identify that it did or did not. Therefore your, you know, attempts to avoid relapse worked. You relapsed your relapse for t. Potentially. There aren't necessarily any. And if you do this, no renewal, no relapse studies, I think it'll happen.

A (55:32)

I think it's bound to happen. I think you just need to know that it's going to be happening and look out for it. Right. So that when you see problem behavior start to inch up, you do something quickly.

B (55:42)

Right.

A (55:43)

Because I. I think that anytime there's a situational change. Right. You're going to see some problem behavior reemerge and it's just like what type or what intensity of problem behavior is going to occur. Right.

B (55:56)

But some small steps you could take would be ensuring that you train across contexts.

A (56:00)

Yep.

B (56:00)

Ideally, the primary context where dangerous or the problem behavior has been occurring in the past.

A (56:06)

You also train across different instructional agents.

B (56:09)

Mm. You want to make sure that's occurring as well.

C (56:11)

Yep.

B (56:12)

And you probably want to do some treatment adherence challenges where you make it as clear as possible. And this, this. I wish I had a little more guidance or the articles are giving more guidance. Exactly what it looks like. Because I was thinking about. I do a lot of training on de escalation, so we'll do a lot of training. Like, here's some strategies you can use to de escalate problem behavior, you know, without a behavior plan, something like, you know, high P sequence type work, some functional communication, prompting. Sometimes you just have to wait. And one of the things that often will happen is we'll do these final role plays and I'll tell people There is a chance that no matter what you do well, it won't help and the child will still engage in aggression or elopement. And you may need to use again physical management because I can't make every single roleplay be like. And as long as you ask me, you know, prompt me to say, help me or give me a candy, it'll work out just fine. Because it doesn't always work out like that in real life. And even when I tell people this might happen, who boy, do I see resurgence a lot in those trainings where all of a sudden they're like, oh, you know, would you like this or this? I hate you. I'm running away. Hey, you can't run away. Stop running away. Sit down. You're a bad kid. It's like, oh man, all the old patterns come jumping right out again. So just telling people, P.S. i don't care what you do, I'm going to throw something at you. You need to stick with it. Probably not a good enough prompt. So what else would you do that to start? I guess probably more practice, more trials of that stopping and giving feedback. Maybe throw it in your BST after they've mastered it before you get into the actual, you know, in situ practice. Maybe do some role play with that too. That might be an idea.

A (57:56)

I love that.

B (57:57)

Yeah. I don't know if it's gonna work,

A (57:59)

but hey, my main take home point is that relapse is not its own thing. That is like mind blowing to me is that it is. It is an umbrella term. And I cannot believe that I did not know this in my whole 45 years of life. So I'm just so thankful that the listener was like, tell us about relapse because I. I am so grateful for you.

C (58:21)

Yeah. Also, incorporating a DRA into the extinction is generally recommended is that can decrease the likelihood of relapse. And then the other recommendation was making sure that the extinction condition and the reinforcement condition are clearly have some type of clear salient cue associated with them that is also thought to potentially help.

B (58:47)

And if you're dealing with a problem, you know, ask for help sooner than later because the longer you sort of deal with the problem, the better the chance that when you learn a new way to respond to the problem, you will engage in some sort of. You will have. Resurgence will occur. There'll be some. Some form of relapse will occur. Just the odds are right.

A (59:08)

Cool. Well, thanks everyone for doing this with me.

B (59:10)

Yeah, thanks. Thanks to our listener for sending in this topic. I thought it was Actually, you know, I was scared of jab, and now we're friends, and I'm not mad at it anymore.

C (59:19)

You're joining the jug band?

B (59:21)

No, they won't have me.

A (59:23)

Oh, well, not yet, anyway.

B (59:25)

They might get. Maybe they'll give me VIP tickets to their show because I did such a nice job describing the article.

C (59:30)

Yeah, maybe they'll let you play the washboard just for one song.

B (59:33)

Maybe. Before we move on to the last section of the show, I want to give you that second secret code word. It is Shaq. S, H, A, C, K. Shack. It's like a crummy house or a love shack with a tin roof.

A (59:47)

Why they made these two things is because that's what I'm doing this weekend. If you put these two words together,

B (59:52)

put the codes together, and you can find where Jackie is. Except by the time this comes out, she will no longer be there.

C (59:58)

All right, I'm also going to tell you about pairings.

B (60:00)

I was about to tell you it was time for pairings.

C (60:02)

Well, it is time for pair.

B (60:03)

I didn't say it. And you had this. This resurgence of interruption to talk about pairings.

C (60:08)

Behavior that. But that's okay. Yeah. Pairings is the part of the show where I tell you about past episodes you might want to check out if you still have questions. We have dabbled in some of these topics that we touched on today across a variety of episodes. They include episode 125, where we talked about resurgence. It was 200 episodes ago, but it feels like yesterday. Episode 84, where Dr. Bill Ahern joins us to discuss behavioral momentum.

B (60:39)

That is, thank God he was there.

C (60:40)

Yes, exactly. Episode 320, Jackie reviews why she hates Dro. Why Jackie hates Dro because some of those same points get pulled here. Episode 297, we discuss the matching law, or at least attempt to. And then episode 223, we talk about generality and generalization. So there's some good stuff in there as well. During pairings, I also like to tell you about a snack that you could enjoy while you're listening to these other episodes. And so our snack for today is cold turkey lay's potato chips. Why, you ask?

B (61:16)

Well, I got the cold turkey. I don't get the latest potato chips.

C (61:18)

Bet you can't eat just one.

A (61:21)

Keep coming back.

B (61:22)

That's not relapse. That's I love these potato chips and want to eat the whole bag of them.

C (61:26)

What if you put them away in the cabinet, which I've seen you do, Rob. Like, no, I'm not gonna eat anymore. And you put away in the cabinet.

B (61:32)

Yeah.

C (61:33)

And then you jump back up off

B (61:34)

the couch and you go, I don't do that.

A (61:36)

I do that with Cadbury mini eggs. So.

C (61:38)

Right. Yeah.

B (61:39)

See, I just leave them out until I say I don't want this anymore because I'm gonna throw up. Then I put them away.

C (61:44)

It's hard to thematically relate foods to all these different topics. So yeah, you know, I think I did a good job. And that was pairings. Please enjoy.

B (61:52)

Let me get some Pringles, because once you pop, the fun don't stop.

C (61:55)

Oh, that's good too.

B (61:57)

Well, everyone, thanks so much for listening to ABA InsideTrack. We hope you enjoyed this episode. Please feel free to leave us a review wherever you like to listen to your pod. Subscribe to the show. Could be Apple Podcasts or wherever. Wherever. No big whoop. If you're interested in getting even more ABA insidetrack content, as well as all of our episodes a week ahead of time, you can subscribe to our Patreon page, patreon.com ABA InsideTrack, where you can get bonuses for CES purchased at the $5 and up levels. At the $5 level, you also gain access to a free CE every season when we do our listener choice episodes. I don't remember when this is coming out because you may. No, you don't have time. You missed the poll. I don't even know what the the winning episode was, but if you ain't a patron, you didn't vote for it. I'm so sorry. You just got to hear it. What are you gonna do? It's gonna be great, I'm sure anyway. But you'll feel bad knowing you had no say. Everyone loves choice. We did that episode too. You can also join at the ten dollar and up level to get access to all of our book clubs the moment they are released and get two CES free for those. So those are gonna come out four times a year and you get three of them a whole year before everybody else. So while everyone else is like, oh, did you like the Anxious Generation? I haven't had time to read it. You're going to be like, not only did I read it, but I heard two hours of great analysis about it as well. So you're going to leave all your colleagues in the dust again. That's patreon.com Aba InsideTrack and you want to join up soon because we're going to be having you might have missed the listener choice poll for whatever season we're in spring, but you have not missed a book club poll yet. If you want to pick our books for the 2026, 2027 year, well, you better get on over there. Patreon.comaba Inside Track all right, well, let's give a couple final thanks. Big thanks to Dr. Jim Carr for recording our intro and outro music, Kyle Stur for interstitial music, and Dan Thab of the podcast Doctors for his amazing editing work. We'll be back next week with another fun filled episode, but until then, keep responding. Bye bye.

A (63:53)

Sam.