Effects of a self-regulation intervention on exercise are moderated by depressive symptoms: A quasi-experimental study

This study investigated whether a computer-based self-regulation intervention increases physical exercise in individuals with or without depressive symptoms. A total of 361 individuals in orthopedic rehabilitation, 36 of them with depressive symptoms, were recruited in Germany. In a quasi-experimental study, individuals were allocated to either a computer-based self-regulation intervention or an online questionnaire. Exercise was measured at the beginning of rehabilitation and six weeks after rehabilitation. Depressive symptoms were assessed at the end of rehabilitation. An analysis of covariance was conducted, controlling for exercise baseline, sex, and phase of assessment. A main effect for depressive symptoms (p = .005) and intervention group (p = .011), as well as a marginal interaction of intervention x depressive symptoms were found (p = .076). Results indicate that the self-regulation exercise intervention in an orthopedic rehabilitation setting seem to be only effective in non-depressed individuals. Future research should examine how health behavior change programs can be designed more effectively for individuals with depressive symptoms.     

Putting the power of behavior analysis in the hands of nonbehavioral professionals: Toward a blueprint for dissemination†

Behavior analysts have much to offer nonbehavioral professionals who work with the communities that we serve. Successful dissemination of behavior-analytic technologies to these professionals could potentially improve their practice. Although the literature contains some exemplary examples of successful dissemination, our discipline would benefit from a blueprint for conducting this important work. In this article, I share our experiences disseminating behavioral technologies to educators, law enforcement officers, and health care providers who engage with neurodiverse individuals. These experiences form the basis of a recommended blueprint for dissemination, which awaits empirical support. After describing this tentative blueprint, I provide suggestions for future research on how best to disseminate our technologies to nonbehavioral professionals, the ideal content of those dissemination activities, and the conditions under which professionals may be more likely to embed our technologies into their best practices.     

Foster mother state of mind and treatment use: Different challenges for different people

On the basis of our research findings from the last 10 years, we have developed a training program for foster parents that targets three critical needs for infants in foster care. This treatment program has now been manualized to allow dissemination to other sites. With our intervention as well as any other, we see it as critical to tailor services to the needs of individual clients rather than adhering in doctrinaire fashion to the manual. In particular, we suggest that attending to foster parents' state of mind with regard to attachment is vital to providing an effective treatment. In this article, we present examples of foster parents with different states of mind and describe how treatment is tailored to meet their individual needs.     

A Data-Driven Perspective: Response to Commentaries by Maguen and Burkman (2013) and Steenkamp et al. (2013)

We respond to commentary from Maguen and Burkman (2013-this issue) and Steenkamp et al. (2013-this issue) on our presentation of how to use PE to treat PTSD resulting from perceived perpetration (Smith et al., 2013-this issue). We focus our response on the distinction between moral injury, which can result in many potential mental health outcomes, with various treatment plans coming out of the patient's presentation, and treatment of PTSD resulting from trauma that may or may not include moral injury. We then focus on the strong evidence base that supports the use of PE for PTSD across trauma types and across many complicated patient presentations, including evidence within veteran populations. We respond to common misunderstandings of PE and Emotional Processing Theory that underlie this treatment model. Specifically, we discuss the flexibility that is inherent in the PE model, reassert that PE focuses on whatever emotion/s are present and provoked by direct confrontation of traumatic material (e.g., reminders, memories), and discuss that habituation is not the only process at work in PE. As such, shame and guilt related to moral injury can be effectively addressed, as noted in Smith et al. Finally, rather than developing a new and unproven model of treatment as the commentaries propose, we assert that given the strong evidence base for efficacy and effectiveness of PE for PTSD and the significant and ongoing investment in dissemination of PE, continued support for providers on how to effectively use PE with difficult patients is warranted.     

Preliminary efficacy of a computer-based HIV intervention for African-American women

This study evaluated the preliminary efficacy of a computer-based HIV intervention to enhance HIV-protective sexual behaviours, based on a randomised controlled trial among 135 African-American women, 21-29 years of age, seeking services at Planned Parenthood in Atlanta, GA. Participants were randomised either to a control session two, 60-minute computer-based HIV intervention sessions administered on a laptop computer that each concluded with a 15-minute small group session or to a control session of general health information including discussion on HIV prevention. Relative to controls, participants in the computer-based HIV intervention were more knowledgeable about HIV/STD prevention and reported higher scores on the measure of condom use self-efficacy at 3 months post-intervention; they also reported a higher percentage of condom-protected sex and were more likely to use condoms consistently for vaginal sex (odds ratio, OR = 5.9; p < 0.039) and were more likely to use condoms consistently for oral sex (OR = 13.83; p < 0.037). This relatively brief intervention provides preliminary support that an evidence-based group-based HIV prevention intervention for young African-American women can be adapted to a computer-based HIV intervention.     

Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions

Assessing treatment fidelity is a core methodological consideration in the study of treatment outcome; it influences both the degree to which changes can be attributed to the intervention and the ability to replicate and disseminate the intervention. Efforts to increase access to evidence-based psychological treatments are receiving unprecedented support; but pressures exist to adapt treatments to service settings, running the risk of compromising fidelity. However, little evidence is available to inform the necessary conditions for the transportation of interventions to service provision settings, and the degree to which fidelity is even evaluated or emphasized in dissemination and implementation programs varies dramatically. Moreover, adaptation is associated with several benefits for dissemination efforts and may address relevant barriers to adoption. A particularly promising strategy for maximizing the benefits of both fidelity and adaptation is the use of transdiagnostic interventions. Such treatments allow for greater flexibility of the pacing and content of treatment, while still providing structure to facilitate testing and replication. Preliminary evidence supports the efficacy of this strategy, which may be particularly conducive to dissemination into service provision settings. At this time, further research is needed to evaluate the relationships among fidelity, adaptation, and outcome, and to determine the potential for transdiagnostic treatments to facilitate dissemination.     

iSTART: Interactive strategy training for active reading and thinking

Interactive Strategy Training for Active Reading and Thinking (iSTART) is a Web-based application that provides young adolescent to college-age students with high-level reading strategy training to improve comprehension of science texts. iSTART is modeled after an effective, human-delivered intervention called self-explanation reading training (SERT), which trains readers to use active reading strategies to self-explain difficult texts more effectively. To make the training more widely available, the Web-based trainer has been developed. Transforming the training from a human-delivered application to a computer-based one has resulted in a highly interactive trainer that adapts its methods to the performance of the students. The iSTART trainer introduces the strategies in a simulated classroom setting with interaction between three animated characters—an instructor character and two student characters— and the human trainee. Thereafter, the trainee identifies the strategies in the explanations of a student character who is guided by an instructor character. Finally, the trainee practices self-explanation under the guidance of an instructor character. We describe this system and discuss how appropriate feedback is generated.     

CREATING NEW REALITIES: PROGRAM DEVELOPMENT AND DISSEMINATION

Program development and dissemination in human services present challenges and opportunities for social scientists. Over the past 27 years the Teaching-Family Model of group home treatment has moved from prototype development to widespread dissemination across North America. Reviewing concepts in industry related to product development and dissemination, the application of these concepts to a human services delivery system, and program replication and dissemination data offer information about how innovative human services can be widely adapted and adopted.     

iSTART: interactive strategy training for active reading and thinking.

Interactive Strategy Training for Active Reading and Thinking (iSTART) is a Web-based application that provides young adolescent to college-age students with high-level reading strategy training to improve comprehension of science texts. iSTART is modeled after an effective, human-delivered intervention called self-explanation reading training (SERT), which trains readers to use active reading strategies to self-explain difficult texts more effectively. To make the training more widely available, the Web-based trainer has been developed. Transforming the training from a human-delivered application to a computer-based one has resulted in a highly interactive trainer that adapts its methods to the performance of the students. The iSTART trainer introduces the strategies in a simulated classroom setting with interaction between three animated characters-an instructor character and two student characters-and the human trainee. Thereafter, the trainee identifies the strategies in the explanations of a student character who is guided by an instructor character. Finally, the trainee practices self-explanation under the guidance of an instructor character. We describe this system and discuss how appropriate feedback is generated.     

The Effects of a Data Dissemination Strategy on the Letter Naming and Object Counting Skills of Preschoolers Attending Head Start

The present study utilized a quasi-experimental design to investigate the effects of a data dissemination strategy on the development of letter naming and object counting skills in preschoolers. The intervention involved the repeated assessment of these skills and a framework for how the resulting data were made available to teachers. The framework highlights: (a) limiting data collection to performance assessments of variables under teacher control, (b) frequent assessment of these variables, (c) graphic display of data and (d) presentation of data in peer-group workshops. The intervention resulted in improved performance on both outcome variables relative to a no treatment control group and a phonics control group. In addition, teaching behaviors were observed to occur during the intervention that predicted child academic outcomes. Discussion is focused on how non-directive data management strategies may improve teacher adherence to evidence-based practices and child academic outcomes.     

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis

As evidence‐based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural‐strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off‐model, nonsystemic formulations/interventions). Of these, “failure to think in threes” appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.     

Consumer engagement and the development, evaluation, and dissemination of evidence-based parenting programs

A consumer perspective can contribute much to enhancing the "ecological fit" of population-level parenting interventions so they meet the needs of parents. This approach involves building relationships with consumer groups and soliciting consumer input into the relevance and acceptability of interventions, clarifying the enablers and barriers to engagement and involvement of parents, and clarifying variables that influence a parent's program completion. The adoption of a more collaborative approach to working with consumers is important if meaningful population-level change in the prevalence of serious social, emotional, and behavioral problems in children and young people is to be achieved. Parents seeking assistance for their children's behavior come from a diverse range of socioeconomic backgrounds, educational levels, cultures, and languages. This paper examines consumer engagement strategies that can be employed throughout the process of program development, evaluation, training, and dissemination, and in "scaling up" the intervention. We argue that a multilevel public health approach to parenting intervention requires a strong consumer perspective to enable interventions to be more responsive to the preferences and needs of families and to ensure improved population reach of interventions. Examples from large-scale dissemination trials are used to illustrate how consumer input can result in an increasingly differentiated suite of evidence-based parenting programs.     

Computer-based intervention with coaching: an example using the Incredible Years program

Increases in personal computer ownership and Internet use patterns provide a potential avenue for dissemination of evidence-based prevention and treatment interventions. The authors describe the implementation of a psychoeducational intervention (the Incredible Years parenting program, which is designed to promote behavioral change in parents and children) using a hybrid model combining computer- and web-based delivery with professional intervention via phone calls, electronic messages, and home visits. The model attempted to simulate many of the parent training methods shown to be successful in the original program. The intervention was implemented with 90 Head Start families who reported elevated levels of child behavior problems. Of the 45 families offered the intervention in the final year of the project, 37 (82%) completed at least half the program and 34 (76%) completed the entire intervention using procedures refined in light of the initial year's experience. These participants reported high achievement of their self-determined goals and were highly satisfied with the intervention. The combination of technology with professional coaching represents a potential model for adapting and disseminating evidence-based interventions.     

The challenge of understanding process in clinical behavior analysis: the case of functional analytic psychotherapy

Whether explicitly acknowledged or not, behavior-analytic principles are at the heart of most, if not all, empirically supported therapies. However, the change process in psychotherapy is only now being rigorously studied. Functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009) explicitly identifies behavioral-change principles used to bring about therapeutic improvements in adult outpatients whose clinical problems stem from ineffective interpersonal repertoires. These principles include contingent responding to behavioral excesses and deficits by a therapist who has established him- or herself as a salient source of social reinforcement. Empirical support for FAP is emerging, but a variety of pragmatic and theoretical questions warrant investigation. Among the issues described in this paper are the training and dissemination of procedures for how to conduct a functional analysis, how to train therapists to identify functional stimulus classes, how to best address decreasing problem behavior without creating an aversive environment, how to enhance generalization, and how to account for the principle of equifinality when trying to specify therapeutic procedures. These and other issues stem largely from trying to disseminate a behavioral principle-based intervention rather than a topographically specified intervention. These issues present challenges and research opportunities for applied clinical behavior analysts if they wish to extend their science to address clinical issues important to the treatment of adult outpatients with normal intellectual functioning.     

The problem: American education the solution: Use behavior analytic technology

In spite of numerous demonstrations that America's youth can be effectively educated with behavior analytic teaching techniques, few of the country's children are benefiting from the technology. In addition scholarly reviews of effective teaching strategies have often omitted reference to behavior analysis. One way to look at this problem is as a two-step operation. First, it is necessary to determine procedures that work; second it is necessary to devise strategies for effective dissemination. The present issue of JOBE (Vol. 1, No. 3, Sept. 1991) contains the recommendations of six outstanding behavioral educators as to how to deal with the dissemination problem. The initial article by Pumroy and McIntire describes the activities of an organization which trains school psychologists and teachers to use behavioral procedures and advocates for the techniques with a number of audiences. Next, Engelmann suggests that the public have more control over school activities and that legal action be taken against irresponsible administrative decisions. Hall advocates for less labor-intensive procedures and the sale of curricular materials based on behavioral principles. Binder proposes that dissemination of the technology become a private endeavor that responds to consumer needs. Rosenfield describes a collaborative model of consultation that increases treatment adherence. Finally, Albers and Greer describe research that isolates a key teacher behavior that results in greater academic proficiency.     

Evaluation of the effectiveness of Face IT, a computer-based psychosocial intervention for disfigurement-related distress

Some people who have a visible difference (disfigurement) experience psychosocial adjustment problems that can lead to social anxiety and isolation. The aim of this study was to assess the effectiveness of a new computerised CBT-based intervention (Face IT) in reducing anxiety and appearance-related distress for individuals with visible differences. Face IT was tested against a non-intervention control group and standard CBT-based face-to-face delivery. Eighty-three participants were assessed at four time points using the Hospital Anxiety and Depression Scales, Derriford Appearance Scale-24, Body Image Quality of Life Inventory and Fear of Negative Evaluation (FNE). The findings indicate a significant reduction in anxiety and appearance-related distress in both the Face IT intervention and the face-to-face condition. Similar findings were reported for depressive symptoms and FNE. Results at the three and six months follow-up demonstrate increased improvements in psychological functioning with both interventions. This new online psychosocial intervention has been found to be effective at reducing anxiety, depression and appearance concerns amongst individuals with disfigurements, whilst increasing positive adjustment. A remote-access, computer-based intervention offers the potential to provide psychosocial support more easily and in a cost-effective manner to adults with appearance-related distress.     

Sexually abusive clergymen: A conceptual framework for intervention and recovery

Effective intervention in cases of parishioner sexual exploitation by clergy can be better understood when placed in a meaningful conceptual framework. To improve our understanding, it is useful to compare clergy abuse to father/daughter incest. Within that context, it becomes more clear how this type of sexual exploitation originates and what intervention strategies are best suited to the situation. Borrowing from the field of sex offender treatment, clergy can also be helped most when a firm yet compassionate intervention is carefully planned and enacted. The experience of an intervention, while emotionally wrenching, can be a positive experience for all involved.Gerald Blanchard, M.A., A.C.P.S., is a clinical social worker in private practice residing in Sheridan, Wyoming. He is a faculty member with the Golden Valley Institute for Behavioral Medicine in Minneapolis and is the author of the recently published bookSex Offender Treatment: A Psychoeducational Model.     

Computer‐Based Intervention with Coaching: An Example Using the Incredible Years Program

Increases in personal computer ownership and Internet use patterns provide a potential avenue for dissemination of evidence‐based prevention and treatment interventions. The authors describe the implementation of a psychoeducational intervention (the Incredible Years parenting program, which is designed to promote behavioral change in parents and children) using a hybrid model combining computer‐ and web‐based delivery with professional intervention via phone calls, electronic messages, and home visits. The model attempted to simulate many of the parent training methods shown to be successful in the original program. The intervention was implemented with 90 Head Start families who reported elevated levels of child behavior problems. Of the 45 families offered the intervention in the final year of the project, 37 (82%) completed at least half the program and 34 (76%) completed the entire intervention using procedures refined in light of the initial year's experience. These participants reported high achievement of their self‐determined goals and were highly satisfied with the intervention. The combination of technology with professional coaching represents a potential model for adapting and disseminating evidence‐based interventions.     

When I Became a Refugee,This Became My Refuge: A Proposal for Implementing a Two-Generation Intervention Using Yoga and Narrative to Promote Mental Health in Syrian Refugee Caregivers and School Readiness in Their Preschool Children

ABSTRACT

This article represents our attempt to establish a blueprint for a comprehensive refugee intervention program to be disseminated across the globe. Specifically, we describe a proposal to conduct a two-generation intervention program that addresses the socioemotional needs of both Syrian caregivers and their preschool children who have fled the atrocities of their home country and have settled in Turkey. The goal is to improve the school readiness skills of preschool children ravaged by war, dislocation, and poverty. First, we describe a caregiver intervention, which consists of trauma-sensitive yoga; second, we describe a child intervention, which consists of a storytelling and story-acting activity. Finally, we discuss how to assess the effectiveness of this two-generation intervention program. Our hope is that this novel intervention program will be implemented in other regions experiencing an influx of refugee families who need immediate psychological services.