Online attention modification for social anxiety disorder: replication of a randomized controlled trial

Social anxiety disorder (SAD) models posit vigilance for external social threat cues and exacerbated self-focused attention as key in disorder development and maintenance. Evidence indicates a modified dot-probe protocol may reduce symptoms of SAD; however, the efficacy when compared to a standard protocol and long-term maintenance of treatment gains remains unclear. Furthermore, the efficacy of such protocols on SAD-related constructs remains relatively unknown. The current investigation clarified these associations using a randomized control trial replicating and extending previous research. Participants with SAD (n = 113; 71% women) were randomized to complete a standard (i.e. control) or modified (i.e. active) dot-probe protocol consisting of 15-min sessions twice weekly for four weeks. Self-reported symptoms were measured at baseline, post-treatment, and 4-month and 8-month follow-ups. Hierarchical linear modeling indicated significant self-reported reductions in symptoms of social anxiety, fear of negative evaluation, trait anxiety, and depression, but no such reductions in fear of positive evaluation. Symptom changes did not differ based on condition and were maintained at 8-month follow-up. Attentional biases during the dot-probe task were not related to symptom change. Overall, our results replicate support for the efficacy of both protocols in reducing symptoms of SAD and specific related constructs, and suggest a role of exposure, expectancy, or practice effects, rather than attention modification, in effecting such reductions. The current results also support distinct relationships between fears of negative and positive evaluation and social anxiety. Further research focused on identifying the mechanisms of change in attention modification protocols appears warranted.     

Efficacy of guided self-help behavioural activation and physical activity for depression: a randomized controlled trial

Behavioural activation and physical activity have received empirical support that highlight their efficacy in reducing depression. Even though both behavioural activation and physical activity share the common goal of reactivating the individual, limited research has directly compared these interventions, and more research is required to evaluate their efficacy when offered in low-intensity formats. The present study involves a randomized controlled clinical trial comparing the efficacy of two guided self-help interventions for the treatment of depression: behavioural activation and physical activity. Fifty-nine participants presenting mild-to-moderate symptoms of depression were randomized either to a behavioural activation intervention (n = 20), a physical activity intervention (n = 19) or a wait-list control group (n = 20). All participants completed symptom measure pre-, mid- and post-intervention, as well as at a two-month follow-up. Mixed-model analyses of variance revealed that both interventions were significantly more efficacious in reducing depressive symptoms in comparison with the control group. Physical activity involved significantly less time-investment compared to the behavioural activation condition (less than half the amount of time). These results indicate that physical activity and behavioural activation both effectively reduce depressive symptoms and are favourably applicable in low-intensity formats. Implications of these results and avenues for future research are discussed.     

Motivational enhancement treatment in outpatient addiction centers: A multisite randomized trial

Background/Objectives: Motivational Enhancement Treatment in Spanish (METS) is a brief intervention aimed at resolving patient ambivalence towards behavior change that has demonstrated efficacy in substance use disorder treatment to reduce use and increase treatment engagement in different populations. In order to have evidence for its implementation in Mexico, a multi-site, randomized, two-arm, controlled clinical trial was conducted at three outpatient addiction treatment centers in the country to compare the effect of METS with Counseling as Usual (CAU). Method: One hundred and twenty patients were randomized to receive three sessions of METS (n = 54) or CAU (n = 66) during the first four weeks of treatment and were assessed during the following 12 weeks. Primary outcome measures were self-reported days of substance use and of treatment services utilization, which were tested using Generalized Estimating Equations. Results: Results associated both conditions with significant changes in substance use over, whereas there were no differences between conditions in substance use or in service utilization. Conclusions: Findings do not support the hypothesis that METS is more effective than CAU, but suggest that brief interventions at treatment initiation may improve patient outcomes.     

Efficacy of an internet-based intervention for burnout: a randomized controlled trial in the German working population

Background and Objectives: Internet-based interventions are a viable treatment option for various mental problems. However, their effects on the burnout syndrome yielded mixed results. In this paper, we examine the efficacy of a structured and therapist-guided internet intervention, based on solution-focused and cognitive-behavioral therapy, for individuals with symptoms of burnout.

Design: Two-arm, Internet-based, randomized, wait-list controlled trial (RCT).

Methods: Participants were recruited through in-house events and online advertising. They were randomly assigned to the intervention or a wait-list. Group comparison was conducted three months after randomization. Outcomes were the burnout level according to the Maslach Burnout Inventory (MBI-GS) and the levels of depression, anxiety and stress according to the DASS-21.

Results: Thirty-nine participants were included in the trial; 36 (92.3%) took part at the 3-months-follow-up. Intention-to-treat analyses revealed significant group differences in favor of the intervention group in depression (d?=?0.66), cynicism (d?=?0.87) and personal accomplishment (d?=?0.75).

Conclusions: The intervention helped ameliorate symptoms of work-related stress and burnout. Although limited by a small sample size, the study suggests that the program provides effective support for affected individuals. However, further studies with bigger sample sizes should be conducted to examine the effects of such programs more precisely.     

PATHS in Croatia: A school‐based randomised‐controlled trial of a social and emotional learning curriculum

This study represents the first rigorous evaluation of a social‐emotional learning curriculum, PATHS (P romoting A lternative Th inking S trategies; Kusché & Greenberg, 1994), in elementary schools in Croatia. This study randomly assigned 29 schools to receive the universal preventive intervention or continue with usual practices. Within those schools, this study included 57 classrooms and 568 children. Teachers rated nine child behaviours in the middle of first grade (pre‐intervention) and near the end of second grade (post‐intervention). Hierarchical linear models, nesting children within classrooms, revealed few changes in behaviour across the sample as a whole or among higher risk children. However, there were changes on eight of the nine behaviours for lower risk children. The findings are considered in the context of the classroom culture and teachers' preparation and readiness to implement a social‐emotional learning curriculum in Croatia. This study highlights the need to supplement universal preventive interventions with selective preventive interventions that can provide more intensive and targeted skill practice for higher risk children. This study also highlights the nuanced effects of a universal preventive intervention in helping different children in different ways.     

走出循证医学的误区——关于证据的反思

循证医学在临床实践中起着越来越重要的作用,证据的可靠性是循证医学赖以生存的基石。循证医学遵循的证据来自随机对照试验,这些证据并非完美。临床医师在采纳这些证据时须注意以下几个方面的问题证据的适用人群,干预措施是否存在均一性,对照是否存在片面性,试验的研究终点是否与临床脱节,证据的时效性,以及随机试验提供的证据不足等。只有结合医生的专业技能和临床经验,考虑病人的价值和愿望,对证据进行正确评估和采纳,才能使证据发挥最大的效能,促进循证医学的发展。     

A survey on adverse incidents in legal psychology studies: Reflections on ethics review

Ethics committees (ECs) regulate research activities to maintain research participants' autonomy and to protect them from harm and injury. No research to date attempted to establish how much risk is involved in social‐science research. Using a survey approach, we set out to estimate the risk of being involved in an incident for research participants in legal psychology and assessed researchers' views of ECs. Fifty‐nine of 188 respondents (31%) stated that they had experienced one or more incidents with a participant. The estimated risk of being involved in an incident was one to three per 10,000 participants, which according to biomedical standards defines a rare risk. Although some researchers were satisfied with their EC, the general tenor was one of discontent due to conservative decision‐making, lacking expertise, and overstepping demands. Whether ECs succeed in protecting participants from loss of autonomy, harm and injury are unknown but are open to empirical research.     

Mand acquisition across different teaching methodologies

Many children diagnosed with an autism spectrum disorder lack functional independent communication. The current study used a combined multiple‐baseline and alternating‐treatments design to evaluate whether the presence or absence of a verbal prompt (asking a question) during teaching affected independent verbal manding. Two teaching procedures were used to teach specific responses (two per teaching condition) and evaluate if the acquired response, once trained, occurred independently (in the absence of stimuli or supplemental prompts). One student learned more rapidly under the mand training condition whereas the other learned at a similar rate under both conditions. The assessment methodology presented may be beneficial in future practice to determine if one teaching procedure is more effective than the other for a learner.     

由新药临床试验中的依从性问题引发的思考

本文就如何看待新药临床试验中的依从性问题提出了自己的看法：应用整体观、认识论的方法辩证地分析、处理依从性问题,以保证临床试验的顺利进行和质量可靠;文中通过实例并结合当前的医改背景,对临床医疗工作中的医患关系提出一些启发和看法,建议医务人员从自身出发重视患者的依从性。     

VIDEO MODELING TO TRAIN STAFF TO IMPLEMENT DISCRETE‐TRIAL INSTRUCTION

Three new direct‐service staff participated in a program that used a video model to train target skills needed to conduct a discrete‐trial session. Percentage accuracy in completing a discrete‐trial teaching session was evaluated using a multiple baseline design across participants. During baseline, performances ranged from a mean of 12% to 63% accuracy. During video modeling, there was an immediate increase in accuracy to a mean of 98%, 85%, and 94% for each participant. Performance during maintenance and generalization probes remained at high levels. Results suggest that video modeling can be an effective technique to train staff to conduct discrete‐trial sessions.