Moving from efficacy to effectiveness trials in prevention research

Efficacy trials test whether interventions work under optimal, highly controlled conditions whereas effectiveness trials test whether interventions work with typical clients and providers in real-world settings. Researchers, providers, and funding bodies have called for more effectiveness trials to understand whether interventions produce effects under ecologically valid conditions, which factors predict program effectiveness, and what strategies are needed to successfully implement programs in practice settings. The transition from efficacy to effectiveness with preventive interventions involves unique considerations, some of which are not shared by treatment research. The purpose of this article is to discuss conceptual and methodological issues that arise when making the transition from efficacy to effectiveness research in primary, secondary, and tertiary prevention, drawing on the experiences of two complimentary research groups as well as the existing literature. We address (a) program of research, (b) intervention design and conceptualization, (c) participant selection and characteristics, (d) providers, (e) context, (f) measurement and methodology, (g) outcomes, (h) cost, and (i) sustainability. We present examples of research in eating disorder prevention that demonstrate the progression from efficacy to effectiveness trials.     

The basolateral amygdala is necessary for learning but not relearning extinction of context conditioned fear

Extinction of conditioned fear involves new learning that inhibits but does not eliminate the original fear memory. This inhibitory learning is thought to require activation of NMDA receptors (NMDAr) within the basolateral amygdala (BLA). However, once extinction has been learned, the role played by the BLA during subsequent extinction procedures remains unknown. The present study examined the role of neuronal activity and NMDAr activation in rats receiving their first or second extinction of context fear. We found that BLA infusion of DL-APV, a competitive antagonist of NMDAr, depressed fear responses at both the first and second extinction. It impaired learning extinction but spared and even facilitated relearning extinction. BLA infusion of muscimol, a GABA(A) agonist, produced a similar outcome, suggesting that DL-APV not only blocked NMDAr-dependent plasticity but also disrupted neuronal activity. In contrast, infusion of ifenprodil, a more selective antagonist of NMDAr containing the NR2B subunit, did not depress fear responses but impaired short- and long-term inhibition of fear at both the first and second extinction. Therefore, we suggest that relearning extinction normally requires NMDAr containing the NR2B subunit in the BLA. However, simultaneous blockade of these receptors and neuronal activity in the BLA results in compensatory learning that is able to promote long-term re-extinction. These data are consistent with a current model that attributes fear extinction to interactions between several neural substrates, including the amygdala and the medial prefrontal cortex.     

Individual differences in Sternberg’s memory scanning task

This study provides a new perspective on both the cognitive processes actually implemented and the effect of a simple experimental control - the recall constraint - in Sternberg’s memory scanning task. These findings were highlighted by adopting a new approach based on the comparison of qualitative and quantitative results.The analysis of individual processing, on 72 adults, each participating in one of two experimental conditions (with or without sequence recall), highlighted a large variability in quantitative results as well as qualitative procedures. Based on the participants’ retrospective verbalisations, two categories of strategies were identified: (1) the procedures used to memorize the sequence of digits, and (2) the procedures used to compare this sequence with the test digit, which includes strategies for coding the items and processes for searching them in memory. The analysis of the strategies shows that their frequencies of use depend not only on the experimental condition, but also on the participants, the level of task difficulty and the interaction between participants and level of difficulty. This variability questions the accuracy of Sternberg’s mean model. Furthermore, this approach suggests some answers to the old debate concerning the exhaustive search pattern for the yes response. Indeed, our results show three types of strategies that can be identified according to the different models of search suggested in the literature. The “exhaustive” search, that would only be involved in the recall condition and only for some of the participants, the “self-terminating” search and the “immediate” strategy, which can be identified with a model of parallel search with limited resources. Thus our study suggests that the different search models are appropriate but depend on both the specific experimental conditions and participant’s strategy. Our results should help to improve the interpretation of data collected with this paradigm in cognitive and neuroscientific studies of memory.     

Impact of auditory selective attention on verbal short-term memory and vocabulary development

This study investigated the role of auditory selective attention capacities as a possible mediator of the well-established association between verbal short-term memory (STM) and vocabulary development. A total of 47 6- and 7-year-olds were administered verbal immediate serial recall and auditory attention tasks. Both task types probed processing of item and serial order information because recent studies have shown this distinction to be critical when exploring relations between STM and lexical development. Multiple regression and variance partitioning analyses highlighted two variables as determinants of vocabulary development: (a) a serial order processing variable shared by STM order recall and a selective attention task for sequence information and (b) an attentional variable shared by selective attention measures targeting item or sequence information. The current study highlights the need for integrative STM models, accounting for conjoined influences of attentional capacities and serial order processing capacities on STM performance and the establishment of the lexical language network.