Choice‐making,Expectations, and Treatment Positivity: How and When Choosing Shapes Aversive Experiences

Every day we use products and treatments with unknown but expected effects, such as using medication to manage pain. In many cases, we have a choice over which products or treatments to use; however, in other cases, people choose for us or choices are unavailable. Does choosing (versus not choosing) have implications for how a product or treatment is experienced? The current experiments examined the role of choice‐making in facilitating so‐called expectation assimilation effects—or situations in which a person's experiences (e.g., discomfort and pain) are evaluated in a manner consistent with their expectations. In Experiment 1, participants were initially exposed to a baseline set of aversive stimuli (i.e., sounds). Next, some participants were given expectations for two “treatments” (i.e., changes in screen display) that could ostensibly reduce discomfort. Critically, participants were either given a choice or not about which of the two treatments they preferred. Participants in a control condition were not provided with treatment expectations. Results revealed that discomfort experiences assimilated to expectations only when participants were provided with choice. Experiment 2 replicated this finding and provided evidence against the idea that demand characteristics and choice‐making unrelated to the core task (i.e., choices without associated expectations) could account for the results. Further, Experiment 2 showed that choosing reduced discomfort because of increased positivity about the treatment. Results are discussed in the context of extant research on choice‐making and expectation effects. Copyright © 2013 John Wiley & Sons, Ltd.     

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.     

The Effects of ‘Face’ on Listening Comprehension: Evidence from Advanced Jordanian Speakers of English

This empirical study examines the extent to which ‘face’, i.e. (audio visual dialogues), affects the listening comprehension of advanced Jordanian EFL learners in a TOFEL-like test, as opposed to its absence (i.e. a purely audio test) which is the current norm in many English language proficiency tests, including but not limited to TOFEL iBT, TOEIC and academic IELTS. Through an online experiment, 60 Jordanian postgraduate linguistics and English literature students (advanced EFL learners) at the University of Jordan sit for two listening tests (simulating English proficiency tests); namely, one which is purely audio [i.e. without any face (including any visuals such as motion, as well as still pictures)], and one which is audiovisual/video. The results clearly show that the inclusion of visuals enhances subjects’ performance in listening tests. It is concluded that since the aim of English proficiency tests such as TOEFL iBT is to qualify or disqualify subjects to work and study in western English-speaking countries, the exclusion of visuals is unfounded. In actuality, most natural interaction includes visibility of the interlocutors involved, and hence test takers who sit purely audio proficiency tests in English or any other language are placed at a disadvantage.     

Cognitive reappraisal reduces perceived exertion during endurance exercise

Emotion regulation may influence psychological responses to exercise. We examined whether the emotion regulation strategies, cognitive reappraisal and distraction, influenced psychological state and prefrontal cortex oxygenation during endurance exercise. Twenty-four endurance runners ran for 90 min at 75–85% maximum heart rate in three separate sessions with no instruction or with instructions to use cognitive reappraisal or distraction. Participants rated their emotional arousal, emotional valence, and perceived exertion before, every 30 min during, and after exercise. Functional near-infrared spectroscopy quantified changes in prefrontal cortex oxygenation. Participants felt lower emotional arousal and physical exertion when instructed to utilize cognitive reappraisal than when given no emotion regulation instruction. Such responses to distraction did not differ from the other conditions. Emotion regulation strategies did not influence emotional valence or prefrontal cortex oxygenation. Participants’ analytical interpretation of the cognitive reappraisal instruction could contribute to small effect sizes and limited effects. Further research should determine contexts under which emotion regulation strategies most benefit endurance exercise experience.     

Longitudinal Impact of a Family Critical Time Intervention on Children in High-Risk Families Experiencing Homelessness: A Randomized Trial

A randomized trial compared effects of a Family Critical Time Intervention (FCTI) to usual care for children in 200 newly homeless families in which mothers had diagnosable mental illness or substance problems. Adapted from an evidence‐based practice to prevent chronic homelessness for adults with mental illnesses, FCTI combines housing and structured, time‐limited case management to connect families leaving shelter with community services. Families were followed at five time points over 24 months. Data on 311 children—99 ages 1.5–5 years, 113 ages 6–10 years, and 99 ages 11–16 years—included mother‐, teacher‐, and child‐reports of mental health, school experiences, and psychosocial well‐being. Analyses used hierarchical linear modeling to investigate intervention effects and changes in child functioning over time. Referral to FCTI reduced internalizing and externalizing problems in preschool‐aged children and externalizing for adolescents 11–16. The intervention led to declines in self‐reported school troubles for children 6–10 and 11–16. Both experimental and control children in all age groups showed reductions in symptoms over time. Although experimental results were scattered, they suggest that FCTI has the potential to improve mental health and school outcomes for children experiencing homelessness.