Randomized Controlled Trial of a Smartphone Application as an Adjunct to Acceptance and Commitment Therapy for Smoking Cessation

There is a major public health need for innovative and efficacious behavioral and cognitive interventions for smoking cessation. This randomized controlled trial evaluated the efficacy of an acceptance and commitment therapy (ACT) smartphone application in augmenting ACT group treatment for smoking cessation. One hundred fifty adults smoking 10 or more cigarettes per day were randomly assigned to 6 weekly group sessions of behavioral support, ACT, or ACT combined with the smartphone application. Access to the app was provided from the start of the in-person treatment until the 6-month follow-up assessment. Participants were encouraged to make their quit attempts after the third session, and the posttreatment assessment occurred 3 weeks later. Measures of smoking status and ACT processes were obtained at baseline, posttreatment, and 6-month follow-up. Biochemically verified quit rates in the combined, ACT, and behavioral support groups were 36% (p = .079 relative to ACT; p = .193 relative to behavioral support), 20% (p = .630 relative to behavioral support) and 24% at posttreatment, as compared with 24% (p = .630 relative to behavioral support), 24% (p = .630 relative to behavioral support) and 20% at follow-up. There was no significant difference (p = > .999) in the primary outcome of biochemically verified 7-day point-prevalence abstinence at 6-month follow-up between the combined and ACT groups. The combined group reported significantly greater smoking reduction, acceptance and present-moment awareness than the behavioral support group at posttreatment, but not at follow-up. There were no significant differences between the groups in positive mental health. Contrary to hypotheses, the ACT group did not display significant improvements in positive mental health or ACT processes relative to the behavioral support group at posttreatment or follow-up. Implications and directions for future research are discussed.     

Primary Care Medical Provider Attitudes Regarding Mental Health and Behavioral Medicine in Integrated and Non-integrated Primary Care Practice Settings

Primary care medical providers (PCPs) have become de facto providers of services for the management of both mental and chronic illnesses. Although some reports suggest that PCPs favor having Behavioral Health colleagues provide behavioral health services in primary care, others demonstrate this view is necessarily not universal. We examined attitudes regarding behavioral health services among PCPs in practices that offer such services via onsite behavioral health providers (n = 31) and those that do not (n = 62). We compared referral rates and perceived need for and helpfulness of behavioral health colleagues in treating mental health/behavioral medicine issues. In both samples, perceived need was variable (5?C100%), as were PCPs?? views of their own competence in mental health/behavioral medicine diagnosis and treatment. Interestingly, neither sample rated perceived access to behavioral health providers exceptionally high. Referral rates and views about the helpfulness of behavioral health services, except in relation to depression and anxiety, were lower than expected. These results suggest a need for increased collaboration with and education of PCPs about the roles and skills of behavioral health professionals.     

A sequential response method of studying complex behavior in animals and its application to the measurement of drug effects

A behavioral testing method was demonstrated to be applicable to the study of detrimental drug effects on complex behavior in rats. The method required the subject (S) to respond in a certain sequence to four identical response sites spaced 90° apart within a cylindrical test compartment. After each S was shaped to perform its one particular sequence within this quadrilaterally symmetrical environment, and its performance was brought to a stable level, drug effects were then studied on a battery of such Ss whose sequential response habits were representative of a continuum of sequence complexity. Experiments with a drug which induces hallucinatory and confusional states in man showed that the method yields in the rat quantitative measures of detrimental behavioral effects in terms of dose-response and dose-time relationships in addition to providing an estimate of the interactive effect between drug dose and behavioral complexity. It was found that for a given magnitude of behavioral detriment, drug dose and behavioral complexity of sequence were inversely related. That is, a S required to perform a simple sequence needed a larger drug dose to interfere with its habit a unit amount that did a S with a more complex one; or, expressed another way, a given drug dose had a greater behavioral effect the more complex the sequence. Finally, an empirical ranking of response sequences along a functional behavioral complexity dimension was presented.     

Examining the Efficacy of Online Administration of a Time-Limited School Readiness Intervention in the Face of COVID-19

Although the efficacy of online administration of behavioral parent training (BPT) programs is well-established, such programs address a single risk factor (behavioral functioning) for school readiness difficulties (comprised of academics, cognitive skills, and social, emotional, and behavioral functioning). The current study aims to examine the feasibility, acceptability, and efficacy of a telemedicine delivery of the School Readiness Parenting Program (SRPP), an integrative adaptation of PCIT designed to address the behavioral and academic domains of school readiness. The present study takes the first step towards validating an online administration of the SRPP as a treatment for early childhood disruptive behavior. Data were collected for 64 children ages 2–6 years (M^age = 4.63, SD = 0.86; 78.1% Hispanic/Latinx) and their families, who received either in-person administration of time-limited PCIT (PCIT-TL; n=30) or online administration of SRPP (n=34). A series of repeated measures ANOVAS were conducted to examine within and between group effects. Results revealed that both SRPP and PCIT-TL significantly reduced inattention (d’s = −0.54 to −0.88), aggression (d’s = −0.55 to −1.06), and behavioral symptomology (d’s = −0.55 to −0.85) and produced significant gains in parental skills (d’s = −1.47 to 2.99). Notably, online SRPP demonstrated greater improvement in positive parental verbalization, whereas PCIT-TL demonstrated greater reductions in parental stress. Overall, findings support the utility of online SRPP for addressing behavioral school readiness concerns.     

Utilization and predicted trends of behavioral inventories

Published articles (N=1703) during the period 1975 to 1982 in three behavioral journals (Behavior Therapy, Journal of Behavior Therapy and Experimental Psychiatry, andJournal of Applied Behavior Analysis) were reviewed for the utilization of preintervention and categories of behavioral inventories. Results revealed that (a) the three forms of the Fear Survey Schedule (FSS) and the Social Avoidance and Distress Scale (SADS) were the most utilized traditional behavioral measures, (b) new self-developed inventories were reported with significantly (p<.05) different frequencies across the three journals, (c) numerous published inventories beyond the traditional FSS and SADS were reported, and (d) an expanded use of IQ measures in preintervention behavioral assessment was also found. Trends regarding the nature of behavioral inventories among the three journals and a discussion on advances in behavioral assessments are presented.     

Motor vehicle accidents and adolescents: An empirical study on their emotional and behavioral profiles,defense strategies and parental support

Background: Research has limitedly focused on adolescents’ emotional–behavioral functioning preceding road collisions and on the role of family support. Objective: To verify whether the rates of motorbikes collisions among adolescents are associated with their emotional–behavioral functioning, their use of specific defense strategies and family support. Method: N = 150 adolescents who visited an emergency department for road accidents were selected and completed self-report questionnaires assessing emotional–behavioral functioning, difficulty in identifying and describing emotions, use of defense strategies and perceived family support. Results: Higher rates of motorbike collisions are associated with more maladaptive emotional–behavioral functioning. Higher perceived family support is associated with lower rates of collisions. Conclusions: Recidivism of motor vehicle collision among adolescents can be considered as a form of acting-out caused by their psychological difficulties.     

Using Motion Tracking to Measure Avoidance in Children and Adults: Psychometric Properties,Associations With Clinical Characteristics,and Treatment-Related Change

Avoidance is implicated in many areas of psychopathology, particularly anxiety and its disorders. Accurate, reliable, valid, and objective measurement of avoidance behavior poses methodological challenges. Two key technological advances, increased computing power and the advent of motion-tracking technology, offer novel solutions to these challenges. We describe a series of three studies using a novel motion-tracking system to measure avoidance in children and adults. The first study examined behavioral avoidance of spider stimuli in large samples of children and adults (N = 200 each; the adults were the mothers of the children). Behavioral avoidance was associated with self-rated fear of spiders and increased state anxiety from before to after the task. The second study examined avoidance of threat faces in children and adults (N = 35 each; the adults were the mothers of the children) and test-retest reliability in the adults. Avoidance of threat faces was associated with broadband anxiety symptom severity. Test-retest correlations in behavioral avoidance measured 6 weeks apart was high and significant. The third study examined behavioral avoidance of spiders in clinically anxious children (N = 25) before and after cognitive-behavioral therapy for childhood anxiety disorders. Behavioral avoidance was significantly reduced following cognitive-behavioral therapy and reduction in behavioral avoidance correlated significantly with improvement in child-rated anxiety symptoms. Taken together, these studies provide strong support for the promise of motion-tracking technology to enable a new phase of behavioral avoidance research with sensitive, valid, reliable, and cost- and time-effective measurement of behavioral avoidance across the lifespan.     

A Randomized Trial to Identify Accurate Measurement Methods for Adherence to Cognitive-Behavioral Therapy

Clinician fidelity to cognitive behavioral therapy (CBT) is an important mechanism by which desired clinical outcomes are achieved and is an indicator of care quality. Despite its importance, there are few fidelity measurement methods that are efficient and have demonstrated reliability and validity. Using a randomized trial design, we compared three methods of assessing CBT adherence—a core component of fidelity—to direct observation, the gold standard. Clinicians recruited from 27 community mental health agencies (n = 126; M age = 37.69 years, SD = 12.84; 75.7% female) were randomized 1:1:1 to one of three fidelity conditions: self-report (n = 41), chart-stimulated recall (semistructured interviews with the chart available; n = 42), or behavioral rehearsal (simulated role-plays; n = 43). All participating clinicians completed fidelity assessments for up to three sessions with three different clients that were recruited from clinicians’ caseloads (n = 288; M age = 13.39 years SD = 3.89; 41.7% female); sessions were also audio-recorded and coded for comparison to determine the most accurate method. All fidelity measures had parallel scales that yielded an adherence maximum score (i.e., the highest-rated intervention in a session), a mean of techniques observed, and a count total of observed techniques. Results of three-level mixed effects regression models indicated that behavioral rehearsal produced comparable scores to observation for all adherence scores (all ps > .01), indicating no difference between behavioral rehearsal and observation. Self-report and chart-stimulated recall overestimated adherence compared to observation (ps < .01). Overall, findings suggested that behavioral rehearsal indexed CBT adherence comparably to direct observation, the gold-standard, in pediatric populations. Behavioral rehearsal may at times be able to replace the need for resource-intensive direct observation in implementation research and practice.     

The links between self-determined motivations and behavioral automaticity in a variety of real-life behaviors

The different motivations postulated by the Self-Determination Theory have proved to be meaningful to predict the level of engagement in a wide variety of life domains. The present research examines the relation between the different forms of self-determined motivation and behavioral automaticity of 12 behaviors associated with different life domains. Following 1743 measurements of self-determination (using a short version of the situational motivational scale, SIMS8), behavioral automaticity (using the self-reported behavioral automaticity index, SRBAI), and behavioral frequency (self-reported number of executions in a unit of time) for 12 various common behaviors collected on 315 young adults (M_age = 20.60?±?2.87 years) through an online survey, the results of crossed linear mixed models indicated that self-determined motivations are more associated with behavioral automaticity than non-self-determined motivations (intrinsic motivation: β?=?0.13, p?<?.001, identified extrinsic motivation: β?=?0.13, p?<?.001; external extrinsic motivation : β?=?0.08, p?<?.001; amotivation: β?=?0.02, p?=?.433). Furthermore, self-determination played a moderating role between the repetition of behaviors and behavioral automaticity (β?=?0.06, p?<?.002) suggesting that self-determination facilitated automatization, as high level of behavioral automaticity was achieved with less frequent behaviors when behaviors were performed for highly self-determined (β?=?0.41, p?<?.001) than weakly self-determined reasons (β?=?0.29, p?<?.001). The applications of these findings for learning and habit formation are discussed.     

Evaluating a model of global psychophysical judgments—I: Behavioral properties of summations and productions

The research presented is a partial empirical evaluation of the second author's proposed psychophysical theory [Luce (2002). Psychological Review, 109, 520-532; Luce (2004). Psychological Review, 111, 446-454]. The theory deals with the global percept of subjective intensity, in which there is a psychophysical function Ψ that maps pairs of physical intensities onto the positive real numbers and represents, in an explicit mathematical way, subjective summation and a form of ratio production. A number of behavioral properties have been shown to follow from these specific representations, and in the presence of certain plausible background assumptions these properties are also sufficient for the representations. In four auditory experiments, key behavioral properties of summation over the two ears and a form of generalized ratio production are evaluated empirically. Considerable support is reported for particular forms of Ψ for summations and ratio productions separately. A second article, Steingrimsson and Luce (Journal of Mathematical Psychology, in press), explores the behavioral properties that link summations and productions.     

The Role of Couple Discrepancies in Cognitive and Behavioral Egalitarianism in Marital Quality

Although gender ideologies and perceptions of equity in the division of household tasks have been associated with marital quality, there is limited understanding of the relationship between discrepancies (in husbands’ and wives’ subjective ideals and accounts of the division of labor) and relationship quality. We examined cognitive egalitarianism (beliefs about gender roles), behavioral egalitarianism (perceptions of the division of household tasks and management), and marital quality among 220 heterosexual, newlywed couples (N?=?440) living in east and central regions of the United States. We used multi-level modeling to examine associations between cognitive egalitarianism, behavioral egalitarianism, and marital quality with a specific focus on discrepancies in the reports of husbands and wives. As hypothesized, both husbands and wives had lower marital quality when their cognitive egalitarianism was discrepant from their partner, and such a discrepancy had a greater influence on wives’ reports of marital quality, especially for wives with higher cognitive egalitarianism. Although we expected similar results for the associations between behavioral egalitarianism and marital quality, we found that the strength of the association between wives’ behavioral egalitarianism and marital quality decreased as the discrepancy from their husbands’ behavioral egalitarianism increased. The association between cognitive egalitarianism and marital quality also increased as behavioral egalitarianism increased for wives but not for husbands. The results of this study illustrate the central role of spousal discrepancy in perceptions and enactment of household labor.     

Yoga in an Urban School for Children with Emotional and Behavioral Disorders: A Feasibility Study

Increasingly, school-aged children present with challenging emotional and behavioral problems and may be resistant to traditional special education approaches (Smith et al., Behav Disorders 36(3):185–194, 2011). These programs do not take into consideration the specific needs of students with emotional and behavioral disorder (EBD). We examined the feasibility and potential for positive effects of yoga sessions within a school setting for children with EBD at an urban elementary school. Thirty-seven children with EBD in an urban school completed a yoga intervention in small groups (7–10 students) twice per week for 3 ½ months. Teachers, parents, and students completed a systematic pre- and post-intervention assessment, and yoga instructors completed attendance and behavior checklists. Average attendance for the yoga sessions was 90 %. Eighty percent of responders described being very satisfied with the intervention. Teachers reported improved attention in class (p = 0.01) and adaptive skills (p = 0.03) and reduced depressive symptoms (p = 0.03), behavioral symptoms (p = 0.01), and internalizing symptoms (p = 0.04). No significant changes were found in the parent data and no discernable trend was found in student reports. These data suggest that yoga administered in small groups in an urban school setting is a feasible school intervention for children with emotional and behavioral disorders and may be effective in reducing symptoms.     

Behavioral Inhibition and Risk for Posttraumatic Stress Symptoms in Latino Children Exposed to Violence

Latino children in urban contexts marked by poverty are at high risk of being exposed to violence and developing posttraumatic stress disorder (PTSD). Nonetheless, there is great variability in individual responses to violence exposure. This study examines risk for developing re-experiencing, avoidance, and arousal symptoms of PTSD as a function of individual differences in behavioral inhibition and exposure to community violence. Participants were 148 Latino students (M age =11.43 years, SD?=?0.69; 55 % girls) living in an area marked by poverty and crime. Children completed self-report measures of behavioral inhibition and posttraumatic stress symptoms during a baseline assessment. During a follow-up interview 6 months later, children completed self-report measures of exposure to community violence since the baseline assessment and posttraumatic stress symptoms. Structural equation models revealed that behavioral inhibition at baseline was positively associated with PTSD avoidance and arousal symptoms at follow-up, after controlling for symptoms at baseline. Furthermore, behavioral inhibition moderated the association between violence exposure and symptoms such that violence was more strongly associated with the development of PTSD avoidance symptoms as behavioral inhibition increased. Results suggest that individual differences in behavioral inhibition contribute to risk for specific PTSD symptoms and are important for understanding variation in responses to trauma exposure. By examining diathesis-­stress models within a disorder, we may be better able to elucidate the etiology of a disorder and translate this improved understanding into personalized intervention approaches that maximize effectiveness.     

Disentangling behavioral intention and behavioral expectation

Social psychologists have extensively researched behavioral intention and its relation to future behavior, usually within the framework of M. Fishbein and I. Ajzen's (1975, Belief, attitude, intention and behavior: An introduction to theory and research, Reading, MA: Addison-Wesley) theory of reasoned action. However, the field has confounded two separate constructs while investigating intention: behavioral intention (BI) and what P. R. Warshaw, B. H. Sheppard, and J. Hartwick (in press, in R. Bagozzi (Ed.), Advances in marketing communication, Greenwich, CT: JAI Press) have coined behavioral expectation (BE), which is the individual's self-prediction of his or her future behavior. In this paper we define both constructs and explain how they differ in terms of the processes by which they are formed, their roles in determining behavior, and their utilities as behavioral predictors. We propose that behavioral expectation is the more accurate overall predictor since many common behaviors are unreasoned (i.e., mindless or habitual) behaviors, goal-type actions, or behaviors where the individual expects his or her intention to change in a foresseable manner. These are all cases where present intention (BI) is not the direct determinant of behavior but where the individual may be capable of appraising whatever additional determinants exist and of including them within his or her behavioral expectation. A study (N = 197) is reported in which student subjects received either a BE (n = 113) or a BI (n = 84) version of a questionnaire pertaining to their performance of 18 common behaviors. Overall, behavioral expectation was the better predictor of self-reported performance.     

Classroom Peer Relationships and Behavioral Engagement in Elementary School: The Role of Social Network Equity

Applying social capital and systems theories of social processes, we examine the role of the classroom peer context in the behavioral engagement of low-income students (N = 80) in urban elementary school classrooms (N = 22). Systematic child observations were conducted to assess behavioral engagement among second to fifth graders in the fall and spring of the same school year. Classroom observations, teacher and child questionnaires, and social network data were collected in the fall. Confirming prior research, results from multilevel models indicate that students with more behavioral difficulties or less academic motivation in the fall were less behaviorally engaged in the spring. Extending prior research, classrooms with more equitably distributed and interconnected social ties—social network equity—had more behaviorally engaged students in the spring, especially in classrooms with higher levels of observed organization (i.e., effective management of behavior, time, and attention). Moreover, social network equity attenuated the negative relation between student behavioral difficulties and behavioral engagement, suggesting that students with behavioral difficulties were less disengaged in classrooms with more equitably distributed and interconnected social ties. Findings illuminate the need to consider classroom peer contexts in future research and intervention focused on the behavioral engagement of students in urban elementary schools.     

Cognitive and Behavioral Contributions to Depression Severity,Quality of Life,and Functioning Among People Living With HIV in South Africa

Cognitive-behavioral treatments for depression typically address both behavioral (e.g., activation) and cognitive (e.g., rumination) components, and consequently improve quality of life (QOL) and function in high-resource settings. However, little is known about the cross-cultural applicability and relative contribution of these components to depression symptom severity, QOL, and functional impairment in South Africa and other resource-limited global settings with high HIV prevalence rates.Persons with HIV (N = 274) from a peri-urban community outside Cape Town, South Africa, were administered multiple measures of depression (Hamilton Depression Scale, Centre for Epidemiological Studies Depression Scale, South African Depression Scale), cognitive and behavioral components related to depression (Ruminative Response Scale, Behavioral Activation for Depression Scale), and measures of QOL and functioning (Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Scale—Short Form). Multiple linear regression models were fit to assess the relative contribution of behavioral and cognitive components to depression severity, QOL, and functional impairment in this population.Models accounting for age and sex revealed that lower levels of behavioral activation (BA) were significantly associated with all measures of depression, as well as with QOL and functional impairment (all ps < .01). Rumination was associated with all measures of depression (all ps < .01), but not with QOL or functional impairment.The consistent and unique association of BA with depression, QOL, and functional impairment bolsters its importance as a treatment target for this population.     

Spouse involvement and a possible long-term follow-up trap in weight loss

The present study was conducted to determine if husband attendance at treatment sessions and participation in behavioral contracting would produce greater weight losses than two other levels of spouse involvement. The three treatment groups investigated did not significantly differ at post-treatment but by 1-yr follow-up female Ss who attended treatment sessions alone and contracted with the counselor (HA) lost significantly more weight than women who attended sessions with their husbands and also contracted with the counselor (HNC). The Ss who attended sessions with their husbands and contracted with them (HC) did not significantly differ from Ss in the other two conditions. The total amount lost by Ss in the HA, HNC and HC conditions by 1-yr follow-up was 16.4, 4.4 and 15.5 lb, respectively. The study was also conducted to collect preliminary data about procedures Ss used during long-term follow-up to ascertain if weight losses during follow-up could be attributed to the behavioral weight-loss techniques learned during the treatment program. At all follow-up periods, many Ss reported using behavioral weight-loss techniques but 4 of the 36 Ss (11.1%) at 1-yr follow-up, 15 of the 23 (65.2%) and 24 of the 25 (96.0%) who responded, respectively, at 3- and 4-yr follow-up had used other weight-loss programs or methods. A possible confound for follow-up data was identified and suggestions for future research were presented.     

Sex,Task, and Behavioral Flexibility Effects on Leadership Perceptions

The effects of sex and behavioral flexibility on leader perceptions were examined in small groups performing under two task conditions. We predicted, based on theory and previous empirical research, that leadership perceptions would be higher for: (1) persons higher in three indicators of behavioral flexibility (self-monitoring, self-reported behavioral capabilities, and androgyny), (2) males in general, and (3) tasks that were sex-congruent. Results showed significant, strong support for behavioral flexibility and sex effects and weak support for the effects of sex-congruent tasks. Exploratory analyses showed thatperceivedtarget capabilities mediated the effects of sex and behavioral flexibility. The discussion is organized around a theoretical model which suggests that target behavior and sex-based cues leading to leader categorization are in part mediated by inferred target capabilities. These capabilities show parallels to leadership-relevant traits such as masculinity, dominance, extroversion, and adjustment, identified in early leadership research.     

Modified Comprehensive Behavioral Intervention for Tics: Treating Children With Tic Disorders,Co-Occurring ADHD,and Psychosocial Impairment

Our objective was to evaluate the feasibility and acceptability, and preliminary efficacy of a modified comprehensive behavioral intervention for tics (MCBIT) therapy for youth with chronic tic disorders (CTDs), co-occurring attention-deficit hyperactivity disorder (ADHD), and associated psychosocial impairment. Seventeen youth ages 10–17 with CTD and co-occurring ADHD were randomly assigned to the MCBIT group (n = 9) or to a control group where they received traditional comprehensive behavioral intervention for tics (CBIT) therapy (n = 8). Both groups received ten 55-minute weekly treatment sessions, and two 55-minute biweekly relapse prevention sessions. Sixteen of the 17 participants completed the study, and acceptability ratings in both treatment groups were high with no significant differences in expectation of improvement. The MCBIT and CBIT groups in combination showed significant improvement in tic severity, ADHD symptom severity, and tic-related impairment. Group differences were not significant. The results indicate that MCBIT treatment is feasible and acceptable for youth with CTD and ADHD, and is similarly well tolerated relative to traditional CBIT. Results were not sufficiently superior to recommend MCBIT over CBIT for this population. However, given the demonstrated benefit of behavioral treatments that target co-occurring conditions concurrently, continuing to examine novel behavioral approaches that can target tics and related conditions simultaneously and successfully is recommended.