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.     

Does Traumatic Brain Injury Attenuate the Exposure Therapy Process?

Research indicates that exposure therapy is efficacious for combat-related posttraumatic stress disorder (PTSD) comorbid with traumatic brain injury (TBI) as is shown by reduced PTSD treatment outcome scores. What is unknown, however, is whether the process of fear extinction is attenuated in veterans with TBI history. Increased PTSD symptomatology and possible cognitive deficits associated with TBI sequelae may indicate additional or longer exposure sessions to achieve habituation and extinction comparable to individuals without TBI history. As such, a more extensive course of treatment may be necessary to achieve comparable PTSD treatment outcome scores for individuals with TBI history. Using a sample of veterans with combat-related PTSD, some of whom were comorbid for TBI, this study compared process variables considered relevant to successful treatment outcome in exposure therapy. Individuals with and without TBI demonstrated similar rates of fear activation, length and number of exposure sessions, within-session habituation, between-session habituation, and extinction rate; results remained consistent when controlling for differential PTSD symptomatology. Furthermore, results indicated that self-perception of executive dysfunction did not impact the exposure process. Results suggest that individuals with PTSD and TBI history engage successfully and no differently in the exposure therapy process as compared to individuals with PTSD alone. Findings further support exposure therapy as a first-line treatment for combat-related PTSD regardless of TBI history.     

Gender role attitudes,relationship efficacy,and self-disclosure in intimate relationships

Drawing from the intimacy process model and data from 5,042 individuals who remained partnered across Waves 1 and 2 of the German Panel Analysis of Intimate Relationships and Family Dynamics (pairfam), this study examined the contributions of traditional gender role attitudes and relationship efficacy in predicting levels of self-disclosure within an intimate relationship. Independent samples t-tests demonstrated females scored higher than males on self-disclosure and relationship efficacy measures but lower on traditional gender role attitudes. An ordinary least squares regression analysis revealed relationship efficacy was a stronger predictor of self-disclosure compared to traditional gender role attitudes, which were not associated with self-disclosure. The findings suggest attitudes with an interpersonal motivational system may be especially important for setting the intimacy process into motion within an intimate union.     

Work,Nonwork, and Sleep (WNS): a Review and Conceptual Framework

The current paper expands on traditional views of the work-nonwork interface to incorporate the critical component of sleep. We integrate past theoretical and empirical work from the sleep and organizational science literatures to inform a novel framework that will facilitate research evaluating associations among work, nonwork, and sleep, the three major areas of life. We propose that attitudes, behaviors, and states emerging in work and nonwork domains cannot be fully understood without taking into account upstream and downstream sleep quantity and quality effects. Rather, periods of sleep bookend engagement in work and nonwork roles. Thus, we propose the work, nonwork, and sleep (WNS) conceptual framework and, in doing so, identify specific, underlying resource mechanisms (i.e., human energy and time) operating both intra-individually and inter-individually. We also discuss contextual factors that act as predictors and moderators of these relationships. We suggest that a unifying framework explaining connections and underlying processes among work, nonwork, and sleep is necessary for applied psychology and management disciplines to significantly contribute to future research, intervention development and dissemination, and ultimately policy change. We provide a number of avenues for future investigation, including relevant special populations and methodological approaches. Although a plethora of work-nonwork theoretical frameworks exist, none have incorporated the third major area of life: sleep. We call for the expansion and acknowledgement of sleep, an important source of variance in everyday attitudes, behaviors, and states, and ultimately in long-term organizational, family, and individual health and well-being.     

Looking forward: the effects of photographs on the qualities of future thinking

Future episodic thinking relies on the reconstruction of remembered experiences. Photographs provide one means of remembering, acting as a “cognitive springboard” for generating related memory qualities. We wondered whether photographs would also invite embellishment of future thought qualities, particularly in the presence (or absence) of associated memories. In two studies participants generated future events in familiar (associated memories) and novel (no associated memories) locations. Half of the participants viewed scene location photographs during event generation. All participants then imagined the events for one minute and completed a self-report measure of content qualities. Results of the current set of studies suggested that for novel locations, no differences in qualities emerged; however, for familiar locations, photographs did not enhance qualities and, in some cases, actually constrained perceptual (Experiments 1 and 2) and sensory (Experiment 1) detail ratings of future thoughts. Thus, photographs did not invite embellishment of future thought details.     

Young Children’s Physiological Reactivity during Memory Recall: Associations with Posttraumatic Stress and Parent Physiological Synchrony

Autonomic reactivity is implicated in stress response and social engagement – both key components of posttraumatic stress disorder (PTSD) – but few studies have examined autonomic reactivity in pediatric samples, and no known studies have examined physiological synchrony among children with PTSD and caregivers. In a sample of 247 young children (94 girls, 153 boys), most (85%) of whom had exposure to trauma and 40% who met criteria for PTSD, we examined children’s patterns of respiratory sinus arrhythmia (RSA) at baseline and in response to a memory recall task, as well as correspondence between parents’ and children’s RSA. Children with PTSD demonstrated significantly higher reactivity than other groups during their recollection of a traumatic memory, but not during other memory tasks. Regarding synchrony, caregivers’ and children’s RSA were more significantly and positively correlated during the trauma recall task among children who had had exposure to a potentially traumatic event but did not meet PTSD criteria, suggesting physiological synchrony may be protective in contexts of trauma. Overall, findings demonstrate physiological reactivity differences among young children with PTSD. While more work is needed to understand the meaning of parent-child physiological synchrony, these data suggest that children’s psychopathology is associated with physiological synchrony processes among young children with exposure to trauma.     

An Approach‐Inhibition Model of Employee Silence: The Joint Effects of Personal Sense of Power and Target Openness

When employees consciously withhold potentially important suggestions or concerns from those who may be able to act on that information, it can have serious implications for organizational performance. Yet there is research suggesting that, when faced with the choice of whether or not to raise an issue, employees often choose to remain silent. Our objective in this paper is to expand current theoretical understanding of why employees often remain silent and of situational factors that can lessen this tendency. Drawing on the approach‐inhibition theory of power, we argue that an employee's personal sense that he or she is lacking in power in relation to others at work is a key factor contributing to the decision to remain silent but that this effect is moderated by perceived target openness. We took a multimethod approach, testing these relationships across 3 studies: a laboratory experiment, a survey study of healthcare workers, and a survey study of employees working across a wide range of industries. Our findings suggest that, although silence is indeed rooted in the psychological experience of powerlessness, perceived target openness mitigates this relationship, encouraging employee to speak up when they would not otherwise do so.