Running head: MORNING REGIMEN SUCCESS WITH MULTI-ELEMENT DESIGN 1
Increasing Morning Regimen Success with Multi-Element Design
Brittany M. Barker
Liberty University-PSYC 320-D05
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Abstract
The target behavior of the subject involves increasing success in terms of adaptation to a new
diagnosis, by means of focusing on morning regimen with the hypothesis that activity levels and
mood increase (sense of productivity or increased quality of life) while depressive tendencies
will decrease throughout the day (acceptance or regimen success). This paper will discuss a
multi-baseline-across-behaviors design, and its impact on the subject’s success in maintaining a
beneficial routine. Measuring the latency, from the time the subject wakes up to the time the
subject begins the first action item listed in the morning regimen outline (MRO), is intended to
decrease the subject’s tendency for procrastination, thus starting the day earlier. There will be
measurement of the duration of the morning regimen, with the goal of decreasing time needed to
complete all items on the MRO, increasing time for productivity or leisurely activities. The last
measurement will be frequency of interruptions, such as distractions of the electronics, dogs,
illness-related discomfort, etc. with intent to decrease, if not eliminate the number of distractions
during the regimen. If all goals are acquired, it is hypothesized that the subject’s general life
quality and productivity will increase after a life-changing diagnosis. The ultimate goal is to
increase success of morning routine by adding recreational activities designed for self-care,
having subject ready for the day at reasonable time, decrease the feeling of inconvenience
associated with new diagnosis by overcoming obstacles, and increasing daily quality of life.
Keywords: respondent, conditioning, reinforcement, continuous, target behavior, latency,
duration, frequency, uncontrolled stimulus, controlled, response, morning, regimen, routine,
Ehlers-Danlos syndrome, EDS, hypermobile, chronic illness, overcoming symptoms, quality of
life, mood
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Increasing Morning Regimen Success with Multi-Element Design
The subject being observed will be observed on multiple baseline levels within the target
behavior of increasing mood and decreasing depressive tendencies related to the diagnoses of
hypermobile Ehlers-Danlos Syndrome (hEDS). The focus of this study takes place at the
beginning of the subject’s day where they have the most problematic behaviors regarding new
adjustments to hEDS. Hypermobile EDS is characterized by hypermobility of joints, skin, poor
wound healing, among other associated symptoms, and has been correlated with fatigue as one of
the more debilitating symptoms (Voermans, Knoop, Van de Kamp, Hamel, Bleijenberg, Engelen,
2010). The subject will be working on a number of behaviors under the “umbrella” of EDS. The
fundamental goal is to decrease symptoms of ailment(s), therefore increasing quality of life. The
subject’s success will rely heavily on the subject’s self-efficacy, which is assumed to be of no
major concern due to the subject’s increased motivation for quality of life improvement.
The subject will be adjusting the morning regimen’s accuracy and success in attempt to
take control of the situation the subject desires to address—additional inconveniences of chronic
illness and undesirable behaviors associated with such. The target behavior is the depressive
tendencies of the subject, some related to hEDS, and some due to prior diagnosis of Major
Depressive Disorder (MDD), which could be considered chronic under some definitions. When
discussing finding gratification in life with people who deal with chronic illness, there was often
discomfort regarding “living life in a way that feels meaningful and enjoyable…and restraining
oneself, spending time on, and limiting mobility in managing illness” (McQuoid, 2017, p. 91). A
man named Brian (age 38) recounts his difficulties living with chronic illness regarding his
kidney failure, and failed transplant. Brian discusses the differences between the known and the
unknown of chronic illness, such as saying:
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“pushing yourself to…[the] point, beyond the pain barrier, that you can actually…realise
that you can feel…indestructible in a way… [for example] when you’re going for a
transplant you do not know what’s going to happen. You go entering the unknown.
(Brian’s leisurely activity choice is rock climbing.) So, if you did the same rock climb
over and over again, that just becomes like walking up a set of stairs. There’s no risk,
there’s no nothing. […] You’re pretty sure that you’ll do your best and you know your
best. And the more you know…the better your guesses can be. […] Ya, I’m fightin’
[laughs].” (McQuoid, 2017, p. 92).
When Brian discusses pushing beyond the pain barrier, it is reasonable to assume he is
referring to the amount of control he feels he has by being able to push, however, with hEDS,
pushing beyond that limit can cause injury or irreparable tissue damage. Thus, introducing, yet,
another obstacle for the subject. McQuoid states, “These accounts of leisure in life with [a
chronic illness] contribute to a largely overlooked aspect of everyday life with chronic illness”
(2017, p. 93). This reiterates the importance of the subject gaining as much control over their
morning regimen because the target behavior is one of the few things the subject can change,
manipulate, and take virtually full control over.
The subject experiences procrastination of getting out of bed daily, starting tasks, etc.,
likely due to a combination of fatigue and MDD, potentially correlated with EDS. Too often, the
subject is too distracted by chronic pain, racing thoughts, or other forms of discomfort, thus
putting off the morning regimen, and consequently, the morning regimen goal will go unfinished
regularly and low productivity will usually result for the day. The subject wishes to decrease the
discomfort of the dissonance by adjusting the current thought of “[subject] should not have to
deal with this at this young age! Why this; why that?” to instead of asking, “Why me?”
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(depressive tendency), ask “Well, why not me? It is what it is, and [the subject] will adjust
accordingly and successfully” (acceptance), hopefully resulting in decreased cognitive
dissonance (depressive tendencies) and increased focus on the task(s) at hand (productivity). For
the purposes of this study, acceptance of new chronic illness diagnosis and regimen success are
considered correlated due to similarities in outcome and potential preventions, for reason to
reflect both the psychological and physical aspects of the study. Productivity and quality of life
will also be considered synonyms in this study, being that both consequences will likely arise
from the same behavior(s), also respecting both the psychological and physical aspects of the
subject’s consequences and final goal of creating a habit for health purposes.
Increasing Morning Regimen Success
The subject will focus on increasing immediate action, reducing procrastination
tendencies, decreasing negative attitudes, decreasing duration of morning regimen, and
ultimately increase feelings of self-control by decreasing, if not removing completely, the
depressive tendencies manifesting into behaviors which can only cause harm to their situation.
The subject wishes to get a better start to their day with increased self-care so that the day
following may trail on in a similar and effective, manner. After some research, it is evident that
people found having a morning regimen unique to them helps productivity for the remainder of
the day. One witness told GulfInsider that “knowing exactly how the first 90 minutes of [their]
day looks like is powerful, as it helps [them] feel in control, which in turn reduces anxiety and
ensures [they are] more productive throughout the day” (GulfInsider, 2015). The witness began
to see the importance of a morning routine for productivity after reading The Miracle Morning
by Hal Elrod (GulfInsider, 2015).
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Another article was written by John Kelly referencing author of The Seven Habits of
Highly Effective People, Stephen Covey, and reiterates the result found by the GulfInsider’s
witness (2011, p. 40). Kelly describes a routine of “putting first things first” by acknowledging
your values, compiling goals, putting first things first, prioritizing, and self-mastery. The subject
wishes to implement this self-goal of “putting first things first”. Other similar testimonies can be
found, with the largest difference being found within the methods and desires of the subject even
though the advice and results are very comparable, thus reinforcing the subject’s desire and self-
efficacy to accomplish these goals for the reward of living a more fulfilling and productive life.
The subject will implement examples from both prior referenced articles, along with some goals
unique to this subject’s situation.
The target behavior of completing a morning regimen (acceptance/regimen success) for
purposes of sense of control, increasing sense of urgency, increasing productivity, and finally
increased moods throughout the remainder of the day, can be summarized by taking steps to
reduce depressive tendencies to increase quality of life (productivity). One aspect of the MRO,
for example, is medication. One study denoted that “medication management is closely related
to chronic illness trajectories…[and] the development of routines is a key challenge in chronic
illness management […] Routines in medication management help people to regain and to
maintain control in their everyday life; however, routines are at risk of being easily disturbed in
chronic conditions” (Haslbeck & Schaeffer, 2009). The consequences can range from a great
mood, a sense of accomplishment, to potentially a perceived self-worth decrease, increase in
symptoms, including pain and fatigue, along with other depressive tendencies or uncontrolled
variants to induce depressive thoughts and/or tendencies.
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Respondent Conditioning Methods & Multi-Element Design
The subject’s response to treatment will likely be highly correlated with the subject’s
everyday life, self-efficacy, and willingness for goal completion. There will be a treatment
specific to each sub-behavior in relation to the behavior’s nature, severity, consistency, etc., in
order to achieve the ultimate goal behavior of completing morning regimen with the objective to
increase productivity for the remaining day, which will be recorded at bedtime daily. The
subject’s antecedent stimulus cannot be controlled, but the target behavior(s) associated can be
manipulated by the subject or with reinforcement, thus reiterating the importance of the high
potency of the positive consequence, thus potential suitable altering by observer.
Some consequences may be altered by way of using a token system. Noor’s results
“suggest people find future commitments easier to make than immediate commitments”, so there
will be an opportunity to enable the subject to exercise their ability to make immediate and future
commitments at similar rates in relation to delayed gratification (2007). Due to the prior
diagnosis of MDD, depressive tendencies are inevitable, therefore, the subject may request a
“token”, or point, to add to another successful day to increase the reward, increasing delayed
gratification tendencies. Use of tokens will be recorded for possible correlation. This variant
will be implemented due to the fact that the subject should not feel punished due to lack of
energy or any other uncontrolled, unavoidable situations outside of subject’s conscious control,
some resulting from their chronic battles like symptoms or doctor appointments. Since
punishment can increase emotional side effects and other unsolicited behaviors, it is important to
ensure the subject does not feel punished for things they cannot regulate (Miltenberger, 2016).
Some consequences may be altered in respects to uncontrolled, unprovoked, and unforeseen
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depressive episodes which are not frequently present in the subject at this time, and have not
been for at least 4-6 weeks.
The subject wishes to avoid the avoidable depressive tendencies by increasing sense of
self-worth, accomplishment, and increased mood by completing morning regimen and
productivity increase throughout the day. The task completion encompasses a physical and
mental aspect when regarding the consequence potency, thus making it necessary to artificially
alter some consequences and avoid neutral stimuli to increase potency of reward. The
completion will be graded on a scale in respects to the number of items completed on the
Morning Regimen Outline (MRO), with deduction points for distractions or other undesirable
sub-behaviors within the subject’s conscious control. If the completion rating is high, the
consequence may be altered, if necessary, to equate appropriately to the behavior’s completion
rating if the subject’s perceived productivity is affected by an external stimulus. The main
correlation to be recorded will be the success of the morning regimen scored by the number of
items completed, pushing through depressive tendencies, etc. (regimen success), in contrast to
the subject’s feeling of accomplishment the remainder of the day, self-rated, relative to perceived
energy level on a given day on a scale of 1-10 indicating perceived “productivity” level (1-lying
in bed with no energy; regimen unsuccessful & 10-excess energy; could participate in intensive
physical and mental activities; regimen 100% successful).
The antecedent stimulus in this study is the presence of hypermobile Ehlers-Danlos
Syndrome/chronic illness (mostly relating to hEDS) resulting in physical and mental difficulties
completing morning regimen and decreased productivity with depressive tendencies. Ehlers-
Danlos syndrome (EDS) has other difficulties correlated with the syndrome, varying by patient,
and prominent effects include chronic fatigue and chronic pain that affects both the psyche and
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physical functionality, in addition to the prior psychological diagnoses, which have been
correlated with EDS as well (Voermans, Knoop, Bleijenberg, & Van Engelen, 2010 & Voermans,
Knoop, Van de Kamp, Hamel, Bleijenberg, & Van Engelen, 2010). These are examples of
uncontrolled variants that will be interpreted throughout the study as well to see if these factors
have a significant effect on the success of the regimen and daily productivity. If correlation is
found, treatment method will adjust accordingly. The unconditioned response (UR) will be the
subject’s perceived average mood throughout the day rated on a scale from 1-10 (1-being one of
the worst days; low self-care/worth to 10-being one of the best days ever; high self-care/worth)
to record the consequence for the behavior that day. For instances where unprovoked depressive
tendencies have an effect on the subject’s perceived average mood/productivity, the uncontrolled
variants will be recorded, and the response will become controlled, only when necessary, in the
respects of artificial altering to ensure the increased potency of the rewards, and the rewards are
appropriate in association with the subject’s actual, not perceived, success of the morning
regimen.
Conclusion
In conclusion, the subject’s self-motivation will play a key role in the success of this
experiment. Since most of the stimuli will be unconditioned, self-control and self-efficacy will
be absolutely needed for accurate results. Rated feelings of self-control will be recorded for
possible correlation, along with other factors with the potential to affect results as mentioned
prior. The motivation to work hard to attain an energy level most people have naturally is
assumed to be a strong long-term motivator for the subject, as the negative consequence of
unproductive behavior will mostly result in a low mood, unproductivity, and self-loathing
tendencies from the depressive disorder. If the subject is able to increase success of morning
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regimen and self-control, it is hypothesized that the subject will begin feeling a heightened sense
of productivity and increased quality of life, thus resulting in less depressive tendencies and
increasing mood levels.
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