Computer-Assisted Therapies: Examination of Therapist-Level Barriers to Their Use

Despite enthusiasm in the field for their potential ease of dissemination, little work has examined whether practicing clinicians are willing and able to use computer-assisted therapies (i.e., computerized treatments designed to be administered with therapist support). For therapists to use these tools, they require access to computer equipment, the skills needed to use the equipment, and willingness to adopt the technology in treatment. This study examined these three factors using survey data from a national sample of mental health clinicians (N = 1,067). Respondents reported on their access to technology and computer fluency, in addition to completing the Computer-Assisted Therapy Attitudes Scale (CATAS), a measure of therapist attitudes designed for this study. Overall, the majority of therapists (90.7%) reported access to at least one computer at work and self-reported computer fluency levels were high. On average, therapists held positive attitudes towards computer-assisted therapies, although expressed concern that these technologies might damage rapport and did not feel that these technologies would improve treatment outcomes. Predictors of positive attitudes included greater general openness toward new treatments, greater comfort with computers, and easier access to technology at work (all ps < .01). Results suggested that, on the whole, therapists may be likely to integrate computer-assisted therapies into their clinical practice. However, therapists vary both in their ability and willingness to use these tools. Implications for the dissemination of computer-assisted therapies are discussed.     

Young macaques (<Emphasis Type="Italic">Macaca fascicularis</Emphasis>) preferentially bias attention towards closer,older, and better tool users

Examining how animals direct social learning during skill acquisition under natural conditions, generates data for examining hypotheses regarding how transmission biases influence cultural change in animal populations. We studied a population of macaques on Koram Island, Thailand, and examined model-based biases during interactions by unskilled individuals with tool-using group members. We first compared the prevalence of interactions (watching, obtaining food, object exploration) and proximity to tool users during interactions, in developing individuals (infants, juveniles) versus mature non-learners (adolescents, adults), to provide evidence that developing individuals are actively seeking information about tool use from social partners. All infants and juveniles, but only 49% of mature individuals carried out interacted with tool users. Macaques predominantly obtained food by scrounging or stealing, suggesting maximizing scrounging opportunities motivates interactions with tool users. However, while interactions by adults was limited to obtaining food, young macaques and particularly infants also watched tool users and explored objects, indicating additional interest in tool use itself. We then ran matrix correlations to identify interaction biases, and what attributes of tool users influenced these. Biases correlated with social affiliation, but macaques also preferentially targeted tool users that potentially increase scrounging and learning opportunities. Results suggest that social structure may constrain social learning, but the motivation to bias interactions towards tool users to maximize feeding opportunities may also socially modulate learning by facilitating close proximity to better tool users, and further interest in tool-use actions and materials, especially during development.     

Neural response to prosocial scenes relates to subsequent giving behavior in adolescents: A pilot study

Adolescence is characterized by extensive neural development and sensitivity to social context, both of which contribute to engaging in prosocial behaviors. Although it is established that prosocial behaviors are linked to positive outcomes in adulthood, little is known about the neural correlates of adolescents’ prosociality. Identifying whether the brain is differentially responsive to varying types of social input may be important for fostering prosocial behavior. We report pilot results using new stimuli and an ecologically valid donation paradigm indicating (1) brain regions typically recruited during socioemotional processing evinced differential activation when adolescents evaluated prosocial compared with social or noninteractive scenes (N = 20, ages 13–17 years, M_Age = 15.30 years), and (2) individual differences in temporoparietal junction recruitment when viewing others’ prosocial behaviors were related to adolescents’ own charitable giving. These novel findings have significant implications for understanding how the adolescent brain processes prosocial acts and for informing ways to support adolescents to engage in prosocial behaviors in their daily lives.     

Automated respiratory sinus arrhythmia measurement: Demonstration using executive function assessment

Respiratory sinus arrhythmia (RSA) is a quantitative metric that reflects autonomic nervous system regulation and provides a physiological marker of attentional engagement that supports cognitive and affective regulatory processes. RSA can be added to executive function (EF) assessments with minimal participant burden because of the commercial availability of lightweight, wearable electrocardiogram (ECG) sensors. However, the inclusion of RSA data in large data collection efforts has been hindered by the time-intensive processing of RSA. In this study we evaluated the performance of an automated RSA-scoring method in the context of an EF study in preschool-aged children. The absolute differences in RSA across both scoring methods were small (mean RSA differences = –0.02–0.10), with little to no evidence of bias for the automated relative to the hand-scoring approach. Moreover, the relative rank-ordering of RSA across both scoring methods was strong (rs = .96–.99). Reliable changes in RSA from baseline to the EF task were highly similar across both scoring methods (96%–100% absolute agreement; Kappa = .83–1.0). On the basis of these findings, the automated RSA algorithm appears to be a suitable substitute for hand-scoring in the context of EF assessment.     

An Evidence-Based,Community-Engaged Approach to Develop an Interactive Deliberation Tool for Pediatric Neuromuscular Trials

Duchenne/Becker muscular dystrophy (DBMD) and spinal muscular atrophy (SMA) are rare neuromuscular disorders that present challenges to therapeutic and clinical trial decision making. We developed an interactive, evidence-based online tool designed to encourage thoughtful deliberation of the pros and cons of trial participation and to inform meaningful discussions with healthcare providers. Prior research demonstrates the importance of tool availability at the time each family is considering trial participation, which may be prior to the informed consent process. The tool is intended to be easily modified to other pediatric disease communities. Tool development was informed by prior qualitative research, literature reviews, and stakeholder input. Specific items were derived based on an online exploratory questionnaire of parents whose children participated in a trial for DBMD or SMA to understand motivations for participation. Parent participants in the exploratory survey reported strong impact of altruistic and individual benefit motivations and placed much greater emphasis on anticipated trial benefits than on harms when making participation decisions. We used this data to develop the evidence-based deliberation tool using a community-engaged approach. We initially targeted the tool for DBMD while using SMA survey data to evaluate ease of transition to that population. We conducted two iterative sets of activities to inform development and refinement of the tool: (1) community engagement of key stakeholders and (2) user experience testing. These activities suggest that the tool may increase deliberation and the weighing of benefits and harms. Ongoing evaluation will determine the acceptability and efficacy of this online intervention.     

Creation and Implementation of an Environmental Scan to Assess Cancer Genetics Services at Three Oncology Care Settings

An environmental scan (ES) is an efficient mixed-methods approach to collect and interpret relevant data for strategic planning and project design. To date, the ES has not been used nor evaluated in the clinical cancer genetics setting. We created and implemented an ES to inform the design of a quality improvement (QI) project to increase the rates of adherence to national guidelines for cancer genetic counseling and genetic testing at three unique oncology care settings (OCS). The ES collected qualitative and quantitative data from reviews of internal processes, past QI efforts, the literature, and each OCS. The ES used a data collection form and semi-structured interviews to aid in data collection. The ES was completed within 6 months, and sufficient data were captured to identify opportunities and threats to the QI project’s success, as well as potential barriers to, and facilitators of guideline-based cancer genetics services at each OCS. Previously unreported barriers were identified, including inefficient genetic counseling appointment scheduling processes and the inability to track referrals, genetics appointments, and genetic test results within electronic medical record systems. The ES was a valuable process for QI project planning at three OCS and may be used to evaluate genetics services in other settings.     

Development and Pilot Testing of a Decision Aid for Genomic Research Participants Notified of Clinically Actionable Research Findings for Cancer Risk

Germline genomic testing is increasingly used in research to identify genetic causes of disease, including cancer. However, there is evidence that individuals who are notified of clinically actionable research findings have difficulty making informed decisions regarding uptake of genetic counseling for these findings. This study aimed to produce and pilot test a decision aid to assist participants in genomic research studies who are notified of clinically actionable research findings to make informed choices regarding uptake of genetic counseling. Development was guided by published literature, the International Patient Decision Aid Standards, and the expertise of a steering committee of clinicians, researchers, and consumers. Decision aid acceptability was assessed by self-report questionnaire. All 19 participants stated that the decision aid was easy to read, clearly presented, increased their understanding of the implications of taking up research findings, and would be helpful in decision-making. While low to moderate levels of distress/worry were reported after reading the booklet, a majority of participants also reported feeling reassured. All participants would recommend the booklet to others considering uptake of clinically actionable research findings. Results indicate the decision aid is acceptable to the target audience, with potential as a useful decision support tool for genomic research participants.     

Cultural Adaptation and Sexual Harassment in the Lives of Asian American Women

ABSTRACT

Despite the prevalence of both historical and current race- and gender-based stereotyping of Asian American women, little is known about their experiences and attitudes regarding sexual harassment. In this study, 109 Asian American women enrolled in a state university or a 2-year community college responded to questionnaires about cultural orientation, experiences of sexual harassment, and sexual harassment attitudes. Asian cultural orientation was associated with sexual harassment attitudes. Specifically, among women with low White cultural orientation, there was a statistically significant positive association between Asian cultural orientation and acceptance of sexual harassment. Results from this study have important implications for clinical practice with Asian American women, including issues of migration, cultural orientation, and the intersection of racism and sexism in the United States.