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University News
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Registered for posting as a periodical category B: price ten cents
Volume 6 Number 9 November, 1975
Dr Collins and his daughter Sukey put the 'Wet Alert' conditioning device
through its paces on a dry run (Photo Here).
Aspects of a Psychologist's
Research
The
treatment of enuresis is one of the specialized research interests of
Dr Robert Collins of the Grand Valley State Colleges , Allendale, Michigan.
Dr Collins is presently spending his sabbatical leave in the Psychology
Department and he will be here until April. He was invited to visit the
University by Professor Aubrey Yates, Head of the Department, who had
become interested in Dr CollinsĂes research and its relation to his own
work in behaviour therapy.
For the past ten years Dr Collins has been conducting clinical studies
on the treatment of enuresis (bed-wetting) in children, mentally retarded
persons and geriatric patients.
As far as children are concerned, he is particularly annoyed by the generalizations
perpetuated in popular publications to the effect that 'time will resolve
all bed-wetting problems'. While most children do achieve continence by
the time they are four years old, ten to twenty per cent do not and the
probability of a four-year-old becoming dry within the ensuing twelve
months in only one in four or, as some studies indicate, one in seven.
For many children, the problem is not resolved for another five or even
ten years.
Dr Collins points out that there are several treatment approaches in use
for enuresis, including psychotherapy, medication and conditioned learning.
His recent research indicates the clinical superiority of the conditioning
treatment over the other methods. But while it is more effective the conditioning
process used is not well understood by many doctors and they often find
it simpler to prescribe medication instead. Since 1962 more than 100 drug
studies have been conducted and many of these have been reported in medical
journals, while only about 35 studies have been done on the conditioning
treatment since it was developed in 1938.
The advantage of medication is that it is convenient and easy to administer
the patient simply takes a pill before going to bed. It usually has an
immediate effect - a dry bed or, most often, simply two to three fewer
wet nights per week overall. The drug is, however, a powerful one, and
its long-term effects have not been studied. Most importantly, Dr Collins
says, medication only works when it is in the person's system; when it
is eliminated bed wetting recurs immediately. So while medication is useful
on a temporary basis, or on occasions when it is important that the client
stays dry, it is far from satisfactory as a general approach to the problem.
The conditioning device which Dr Collins uses in his research is based
on an apparatus developed in 1938 by the American psychologist, O.H. Mowrer.
The pad and buzzer set is available without a prescription in the U.S.
at prices from $25 to $50. By following the directions parents can use
it without supervision by a doctor or psychologist. Dr Collins has not
yet discovered similarly reliable and inexpensive devices in Australia.
Initially, he cautions, a physical examination should be made, and close
professional supervision would of course be desirable and should be sought
if no positive effect occurs.
One advantage of this approach is that, while commonly used parental devices
such as potting during the night or restricting drinks before bed time
often increase a child's anxiety and hostility, the conditioning approach
does not. Youngsters respond well to using the impressive-looking apparatus
and the likelihood of becoming dry - and two-thirds in fact do.
The apparatus consists of a grid and a mat, both made from metallic strips,
separated by a sheet of cloth. The two metallic elements are connected
to a buzzer device, as shown in the photograph. As long as the separator
sheet is dry no current can be conducted. When the child begins to urinate
a circuit is completed and the buzzer sounds. (There is no danger of shock
since the buzzer operates on a low voltage.)
All in all Dr Collins believes that the specificity and efficacy of the
conditioning treatment for enuresis is well established by his research,
which has employed comparisons similar to those required to testing the
effectiveness of medication. At this time he notes that it remains to
better delineate the various processes and factors that can account for
its effectiveness and to promote its appropriate and successful clinical
use.
As part of his research work here Dr Collins has designed a chamber fitted
with a similar apparatus which he will use to toilet train a group of
rats. While little study has been done in this area he believes that some
animals may also wet in their sleep at times and that this project can
help give more precise understanding of the complex skills involved in
bladder sphincter muscle control and their interaction with sleep.
Aug.
31, 1976 The
Advance
GVSC psychologist
researches a cure for bedwetting
Robert W. Collins, Ph.D., associate professor of psychology
in the College of Arts and Sciences at Grand Valley State Colleges, recently
completed an eight-month visiting appointment at the University of Western
Australia's psychology dept., where he continued his research on biofeedback
or conditioning means of treating bedwetting.
Dr. Collins jointly initiated a continuing research-treatment program
with Dr. Desmond Poole in the Dept. of Psychiatry at the Australian university's
medical school, through a special bedwetting clinic. Presentations of
future research and treatment programs were made at several Australian
universities highlighted by a joint lecture to staff members of the Royal
Children's Hospital in Parkville, Victoria, by Dr. Collins and Dr. Bernard
Neal, dean of postgraduate medical studies at the Children's Hospital.
This facility is said to have one of the oldest and largest bedwetting
clinics in the world.
Dr. Collins plans to conduct similar parallel treatment studies in the
Grand Rapids area, with the assistance of area physicians. He also is
available for talks in his area of expertise. Dr. Collins recently published
two studies on enuresis (bedwetting).
The Georgetown resident has also been invited to present a paper entitled,
"Revolution versus Resolution in Research on Urinary Continence" at the
upcoming national convention of the American Psychological Association
in Washington, D.C. Its reading will be part of a symposium on "Enuresis:
Four Decades of Treatment and research."
Section B
Friday, February 9, 1979 The Ann Arbor News
Dimensions
A primary drama that goes on every night
Why does your
child still wet the bed? Why, of course, because he or she was born wetting
the bed. The more interesting and productive question, according to associate
professor Robert Collins, who's on the faculty at Grand Valley State College
in Allendale near Grand Rapids, is how is it that most of us manage to
stop wetting the bed? Even the normal non-bedwetters among us, Collins
says, come very close to wetting the bed every night. "You don't know
how close you come," Collins says dramatically. "It's a primary drama
that goes on every night. Just in the nick of time, you clamp up. It is
so close. You come very, very close to losing it."
Collins, who was often introduced as a "pyssologist' by funpoking Australians
when be spent a year there, was in Ann Arbor last week to speak to students
in James Papsdorf's course in behavior modification.
Collins became interested in the problem of bedwetting while teaching
at Indiana University several years ago. A 27-year-old female graduate
student was about to get married, and was distressed about the possibility
of her bedwetting dampening her groom's ardor. Collins began researching
the subject, cured her in time for the ceremony, and received a Christmas
card inscribed with the grateful message: "How dry I am!
ABOUT 80 PERCENT of all children, according to Collins, will stop wetting
the bed at night by the age of four. But the other 20 percent, despite
a parent's or physician's fondest hopes, may not grow out of it easily.
"The chance that a boy or girl at age five or 10 or 13 or any age will
stop wetting the bed in the next 12 months is somewhere between one in
four and one in seven," Collins says. "If we leave it to time, time doesn't
do a very good job."
How Do You Help a Bedwetter
Stop Wetting the Bed?
Collins
believes the best approach is still the one devised back in 1938 by a
couple of houseparents, Dr. O. H. Mowrer and his wife Willie Mae, at a
residential treatment center for children. Mowrer's logic was as follows:
it is the contraction of the sphincter muscles at the neck of the bladder
which prevents the expulsion of urine from the body. During the day "pressure
cues" from the full bladder tell us when "it's time to go," and to contract
those sphincter muscles until we get to the toilet. For bedwetters, those
"pressure cues" are just not being picked up during sleep. But any noise,
a slamming door, a truck rolling by, causes us to contract the sphincter
muscles while we are sleeping. You can teach a child to pick up the missing
pressure cues if, whenever he begins to wet the bed, be is immediately
awakened by a noise.
Mowrer's Solution was
to rig up a bed to a hinge so that when the child in the hinged bed wets
the sheets, the wet urine would complete the low-voltage electric circuit
in an "electropad, " which would then kick on a switch which would cause
the hinge to release the bed. Thus the child who began wetting the bed
quickly ended up on the floor. "It's a classical conditioning account,"
Collins says.
The "sensor" or "electropads" that are now sold in department stores to
cure bedwetting work on the same principle as the one devised by Mowrer,
but instead of pitching the child to the floor, they simply set off a
loud buzzer.
Collins, as part of his doctoral dissertation studies, performed an experiment
with 60 children to test the effectiveness of the electropad bedwetting
cure. The results of his study convinced him that the pad does make a
"clear contribution" to the cure.
Collins thinks it's the best cure going. "More than 80 percent of all
children who use an electropad, with proper supervision, will stop wetting
the bed within 3 months", Collins says. "Ten to 50 percent of those children
will begin wetting the bed again, however. Most of them will stop with
a reapplication. I tell parents that the bladder is dumb. Anything that's
learned can be forgotten".
Collins doesn't buy the logic that all bedwetting is caused by emotional
problems and that by forcing a cure with an electropad you simply cover
up the child's problems. "Most often bedwetting is not due to underlying
emotional problems, " Collins insists. "It's the reverse. The emotional
problems derive from the bedwetting. The whole emotional climate of a
home is improved when a child gains control over his bedwetting problem."
Collins does not approve of the use of medication for most bedwetters.
"The relapse rate with imipramine, a commonly prescribed drug for bedwetters,
is about 80 percent," he says. "It doesnĂt do a very good job."
4-B
The Grand Rapids Press, Tuesday, November 6, 1979
Bedwetting Problems Usually Are Curable, Enuresis
Expert, Enuresis Expert Says
By Jim Mencarelli
When
Robert Collins was a graduate student at Indiana University, he encountered
a curious problem. Another graduate student at the school in Bloomington,
Ind., a 27-year-old woman, was engaged to be married. However, she still
wet the bed. "Obviously, she was terribly worried about the effect of
bedwetting on her groom," Collins says. "She hoped we would be able to
help her before the wedding."
That incident spurred a lifelong Interest for Collins who, at 41 is one
of the world's experts on enuresis better known as bedwetting. Today,
he's an associate professor of psychology at Grand Valley State Colleges
and is in private practice in Grand Rapids.
"It's not all that uncommon for adults to wet the bed," Collins continues.
In the case involving the woman, "We came across a bedwetting alarm and
had one made up. "She tried it and dried up completely. For years after,
she sent Christmas cards saying, 'How dry I am.'
There are numerous stereotypes about bedwetters, most of them untrue,
according to Collins, who gained much of his practical experience doing
clinical research in Madison, Wis. "The question to ask is not why people
continue to wet the bed but why they ever stop in the first place. Collins
says, "We're all bedwetters when we start out in life." Collins believes
bedwetting is not pathological. The psychological and social adjustment
problems often thought to cause bedwetting actually develop as symptoms
of the problem. "Children who wet the bed become insecure," he says. You
have to be careful because it's so easy for them to get feelings of guilt
and shame. "The bedwetting itself causes the other problems such as a
poor self-image.
When a bedwetter learns to be dry, he immediately feels much better about
himself. "He quickly learns he's okay and the problems usually clear up."
Collins is not certain what creates a bedwetter. Most people stop wetting
before age 4. "I think what happens is the wet bed acts like an alarm.
The kids learn not to like a wet bed. It's uncomfortable. Their parents
don't like it. So they learn on their own to stop wetting at night. "There
Is some evidence that a bedwetter is not bothered as much by his own wetness.
The bedwetting occurs in the deep stage of sleep, and the child simply
doesn't wake up in time."
Another theory Collins expresses has to do with an urine production system
that somehow loses its sense of time. "We have a 24-hour rhythm of urine
production. We produce most of our urine during the daylight hours and
the kidneys concentrate more urine at night. "With some real problem bedwetters,
their kidneys donĂt concentrate the urine enough at night.."
Whatever the cause, Collins says that if a child still is wetting the
bed after age 4, the parents should seek professional help. "Roughly 15
to 20 percent of children become problem bedwetters. By puberty, 2 to
4 percent are still wetting their beds. I feel sorry for them because
they often feel terribly frustrated by their lack of control.
According to national averages, between 2 to 3 percent of the adults in
Grand Rapids are bedwetters, Collins says. "This is interesting because,
so far, I've only been approached by one adult. I think the others simply
are too embarrassed to come in for help," Collins says. That and theyĂve
probably had some pretty bad experiences with promised cures."
Unless bedwetting is caused by a physiological problem, and only 5 to
10 percent of problem cases are, Collins says, bedwetting can be cured.
Besides his clinical work in Indiana, Wisconsin and Michigan, Collins
has worked with bedwetters in Australia, where he was a visiting professor
at the University of Western Australia in 1975 and 1976.
He says his work has convinced him that the best cure is the Pavlovian
approach first tried by, Dr. H. Mowrer and wife, Willie Mae, in 1938.
The couples' solution was to rig up a bed with hinges connected to a low
voltage lock. When a child began to wet, the wet sheets completed an electrical
connection which released the hinges. Suddenly, the bedwetter found himself
on the floor.
Collins' technique is to rig up a sound alarm system to the sheets. When
the wet sheets make the electrical connection, a buzzer or bells go off,
waking up the bedwetter. Gradually, through "conditioning," the bedwetter
learns to wake up before his bladder empties.
"Doctors often tell parents with problem bedwetters that the children
will grow out of it. But the chances of it being your child that will
'grow out of it' within the next year are between I-in-4 and 1-in-7,"
Collins says. With treatment, however, Collins says 30 to 40 percent of
bedwetters can "dry up" during the first month in the second month, an
additional 36 percent dry up. Hard-to-cure cases take longer. "As with
anything, there are a few relapses," he adds. "But it a something that
can be relearned fairly easily."
Grand
Rapids Press Editorial Page
August 18, 1982
Cures
Your
Aug. I I Associated Press article "Bedwetting: Often a Physical Problem"
will evoke much parental interest. As a psychologist, I quite agree with
downplaying the outmoded psychoanalytical view that bedwetting is due
to emotional problems. Also, the article's statement that about "60 percent
of all bedwetting is the result of bladder spasms" is not unreasonable.
However, concerned parents should know:
1. Children will not easily "grow out" of the problem. After age five,
only about one in five will become dry in the next year. Time alone has
a lousy "cure rate."
2. The anticholinergic medications which are mentioned in the article
are quite powerful and have immediate side effects which parents and children
may reject as unacceptable.
3. The long-term side effects of anticholinergic medications for children
have not been adequately studied.
4. Medications operate on the physical problem" only as long as they are
effectively present in the body. The article implicitly acknowledges this.
Your readers should also note that behavior treatments have been developed
which, in effect, "educate" the bladder to be less spastic. Similar procedures
such as biofeedback have been shown to be effective for other "physical
problems." Generally, the behavioral procedures are effective, more benign,
and have lower relapse rates than the medications. Cooperating physicians
and psychologists can provide many more valid alternatives today for all
kinds of problems than are implied by oversimplifying some problems as
either "physical" or "emotional."
ROBERT W. COLLINS, Ph.D., PC
50
People Who Make a Difference: Retired SL psychologist offers solutions
over the Web (08/08/2006)
BY
MARK BROOKY
mbrooky@grandhaventribune.com
SPRING
LAKE — Dr. Robert Collins, 67, says he's found "the perfect retirement
job." The retired psychologist can check on his clients anywhere
he can hook up to the Internet.
Click to enlarge (missing photo)
With
the base of his operations in the basement of his Spring Lake Village
home, Collins sells detailed manuals for treating bed-wetting and incontinence
problems. His Web site also offers the latest news on the subject, a support
forum and free consultations.
"I
knew that I had something better, and the Internet made that possible,"
he said. "So I manualized the treatment. I put it down in simple,
written (language) on how to treat bed-wetting and soiling."
Collins
was professor of psychology at Grand Valley State College from 1969-81,
and spent a year at the University of Western Australia as a visiting
professor. But it was while he was working on his doctorate at Indiana
University that he picked up on an effective treatment for the distressing
problem of bed-wetting.
"We
had a 27-year-old graduate student come into the clinic who was anticipating
getting married, and she had this bed-wetting problem," Collins recalled.
"Bless her fiancé, he was willing to marry her despite knowing
that she might go off at anytime in the night."
Knowing
of a device invented by Dr. O. Hobart Mowrer in 1938, Collins rigged a
screen-wired bedsheet, which triggered an alarm when wetting completed
a circuit. The device is based on the famed Pavlov principle of conditioning.
"I
didn't know it at the time, but you could've ordered these from Sears
Roebuck or Montgomery Ward," he said. "We went through this
fancy-shmancy stuff of reinventing the wheel."
Since
bed-wetting solutions was only part of his private practice — he was president
of Psychological Services Center, with offices in Grand Haven, Holland
and Muskegon, until he retired in April 2002 — Collins started the Web
site (www.soilingsolutions.com) in 1998. He figures he's sold over 1,600
manuals since then to families across the United States and several other
countries.
An
increasing part of his online help service is dealing with uncontrolled
bowel movements, which he said is even more distressing for children —
some as old as 13 — and their parents, as well as the elderly and their
caregivers, than bed-wetting.
"The
number one or two reasons you give up on old people and they go into a
nursing home is when they are bowel incontinent," Collins said. "Caregivers
can't handle it when they get to that point."
Collins
said soiling and bed-wetting have nothing to do with depression, although
depression medications are often prescribed in an effort to solve the
problem. A likely major cause for bed-wetters is that they experience
a deeper level of sleep and don't recognize the need to urinate.
"It's
behavioral," Collins explained. "It's the failure of the brain
to recognize the signals that the bladder is getting full and it's beginning
to get active, and the child is not responding to that appropriately.
The treatment is behavioral conditioning."
He
said many pediatricians, researchers and students also gather information
from his Web site.
"Everything
I'm doing is to get the natural signal to become active," Collins
said. "... That is the major contribution that I feel I've made."
Collins
met his wife, Sherron, when both were students at Kent State University.
She's been a leading organizer of the annual Spring Lake Heritage Festival.
They have two grown children: Gregory, 37, lives in Coopersville; and
Susannah, 33, teaches dance in Tucson, Ariz.
Please
mail us any articles in the popular press dealing with enuresis or encopresis.
RWC
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