Lessons Learned From a Randomized Controlled Pilot Trial Testing an Inhibitory Learning Approach to Exposure in Anxious Youth

Accumulating evidence from basic and translational research indicates that fear extinction may be best explained by principles of “inhibitory learning,” by which prefrontal cortical structures inhibit activity in the amygdala. New guidelines for the clinical practice of exposure therapy have arisen from research on inhibitory learning, but these guidelines have received little empirical testing in clinical samples of youth receiving treatment for anxiety disorders. We investigated the acceptability, feasibility, and initial efficacy of conducting exposure therapy for anxiety disorders in youth according to clinical guidelines developed from basic research on inhibitory learning principles, using a pilot randomized controlled trial design. Thirteen youths (ages 7 to 16) were recruited from a university hospital-based pediatric outpatient clinic to participate in a 9-week treatment study and were randomized to either an inhibitory learning-based exposure condition or a standard exposure condition. Results supported the feasibility and acceptability of an inhibitory learning-based approach to exposure therapy in youth and, despite the small sample size, effect sizes were in favor of the inhibitory learning approach on several measures. Differences between the standard exposure and inhibitory learning conditions are discussed using two case examples. Discussion of results and lessons learned may contribute to changes in clinical guidelines for optimally effective practice of exposure.     

Participatory work place intervention for stress prevention in primary health care. A randomized controlled trial

The aim of this study is to explore whether a participatory, organizational intervention can reduce work-related risk factors, and thereby prevent stress-related ill health. We build on the job demand-control and effort-reward imbalance models of stress. It is a two-armed randomized trial, with one primary health care unit receiving the intervention and a two-unit control group. Validated questionnaires for the assessment of psychosocial work environment and health were administered, at the baseline and at 6 and 12-month follow up. The primary outcome was job strain. Secondary outcomes were effort–reward imbalance, exhaustion, sleep, and recovery. Group-level objective data on workload and data about relevant processes during the study were continuously collected. The changes in the intervention group with regard to job strain, effort-reward imbalance, exhaustion, sleep and recovery were not statistically different from changes in the control group. For the non-exhausted employees though, reward was significantly higher at follow up compared to baseline, but only in the intervention group. An important piece of information is that the objective workload was statistically significantly higher in the intervention group throughout the study. Not all the components of the intervention were implemented as intended. Context and process information, such as objective data and implementation fidelity are necessary for a valid interpretation of the results.     

Can a twelve-week intervention reduce barriers to bicycling among overweight adults in low-income Latino and Black communities?

This pilot study summarizes perceived barriers to bicycling among overweight adults in two low-income communities of color and evaluates the impact of a bicycling intervention on these perceived barriers. A randomized controlled trial with 38 total participants from one predominantly Latino and one predominantly Black neighborhood in Milwaukee, Wisconsin was conducted during summer 2015. The twelve-week intervention consisted of group bicycle rides and bicycling instruction. Several barriers identified prior to the intervention declined significantly among intervention group members soon after it was completed: not feeling healthy enough to bike, being physically uncomfortable while biking, not having a bicycle to use, not having other people to bicycle with, not knowing the best routes to use, not feeling safe from crime, not feeling safe from car traffic, and worrying that neighbors do not think it is normal for an adult to ride a bike. Eight weeks after completion, the intervention group reported significantly greater reductions than the control group with respect to the barriers of not feeling healthy enough to bike and not feeling safe from car traffic. In addition to decreasing barriers, qualitative analysis suggested that increasing support from family and friends as well as emphasizing personal health benefits could help motivate people to bicycle.     

Questionnaire d’efficacité de la consultation : élaboration et validation préliminaire d’une échelle de mesure de l’efficacité de la consultation en gestion

Despite sustained interest of both researchers and practitioners in favor of a reliable measure of management consulting effectiveness, the existing assessment instruments remain scarce, poorly validated and often inadequate. This study proposes a new instrument for assessing management consulting effectiveness from the consultant's point of view: The Consulting Effectiveness Questionnaire (Questionnaire d’efficacité de la consultation). The preliminary empirical validation of the questionnaire was conducted using two samples of 116 and 207 consultants. Exploratory and Confirmatory factor analyses suggests a second-order two-factor solution, namely the Quality of the process and Value-added results. The results offer preliminary support for the psychometric properties (validity and reliability) of this promising tool for both research and practice purposes.     

A randomized controlled pilot trial of acceptance and commitment training (ACT) for preventing stress-related ill health among future nurses

Background: Levels of stress and burnout increase during nursing education. This development has consequences for nursing students' health, learning, competence, and interest in quality issues in health care. Design: In a randomized controlled pilot trial with a sample of 113 nursing students the effect of an intervention using techniques from acceptance and commitment training (ACT) to prevent the development of stress and burnout was evaluated. Method: The 6 × 2-hour program was compared to standard treatment (reflection seminars) post-intervention and at a three-month follow-up using longitudinal analysis of mean response profiles. Mechanisms of change were investigated using a baseline-post intervention two-mediator model. Results: The intervention resulted in increased mindful awareness and decreased experiential avoidance, as well as decreased perceived stress and burnout. Levels of mindful awareness and perceived stress were sustained at follow-up. The proposed mechanisms of change were partly supported by the data. Conclusion: This study shows that techniques from ACT might have the potential to contribute to preventing the development of stress and burnout during nursing education. However, additional studies are needed to validate these results.     

Clinical Trials Infrastructure as a Quality Improvement Intervention in Low- and Middle-Income Countries

Mounting evidence suggests that participation in clinical trials confers neither advantage nor disadvantage on those enrolled. Narrow focus on the question of a “trial effect,” however, distracts from a broader mechanism by which patients may benefit from ongoing clinical research. We hypothesize that the existence of clinical trials infrastructure—the organizational culture, systems, and expertise that develop as a product of sustained participation in cooperative clinical trials research—may function as a quality improvement lever, improving the quality of care and outcomes of all patients within an institution or region independent of their individual participation in trials. We further contend that this “infrastructure effect” can yield particular benefits for patients in low- and middle-income countries (LMICs). The hypothesis of an infrastructure effect as a quality improvement intervention, if correct, justifies enhanced research capacity in LMIC as a pillar of health system development.     

The Effects of Modafinil on Convergent and Divergent Thinking of Creativity: A Randomized Controlled Trial

Modafinil is a drug licensed for the treatment of narcolepsy and sleep apnea. Recently, modafinil has been reported to be used as a pharmacological cognitive enhancer by healthy individuals with no psychiatric disorders. This paper reports on a study that investigated the effects of modafinil on divergent and convergent thinking tasks of creativity. Sixty‐four healthy male (n = 31) and female (n = 33) volunteers participated in a randomized double‐blind placebo‐controlled parallel group design study. For the convergent thinking tasks, modafinil had no significant main effect on the Group Embedded Figures Task and the Remote Associates Task (RAT). However, a median split analysis showed that modafinil participants low in creativity personality trait had significantly higher RAT scores (Mean [M] = 6.85, SD = 3.39; 95% confidence interval [95% CI]: 5.53–8.2) than those high in creativity personality trait (M = 4.27, SD = 3.0; 95% CI: 2.4–6.0). For the divergent thinking tasks, relative to placebo (M = 1.195, SD = 0.28; 95% CI: 1.0–1.3), modafinil (M = 0.77, SD = 0.37; 95% CI: 0.63–0.92) significantly reduced the performance of flexibility scores and marginally reduced the elaboration scores as measured by the Abbreviated Torrance Test for Adults (ATTA). Overall, participants on modafinil (M = 6.3, SD = 2.6; 95% CI: 5.3–7.4) had significantly lower ATTA scores relative to participants on placebo (M = 9.5, SD = 2.3; 95% CI: 8.6–10.4). These results indicate that modafinil might reduce divergent thinking of creativity in healthy individuals. They suggest that, rather than being a more general cognitive enhancer, modafinil might have negative and subtle effects on creativity. However, the results are from a small‐scale trial, which tested a small number of participants. Therefore, the results need to be interpreted with caution. A replication with a large sample of participants is recommended.     

A Scanpath Analysis of the Risky Decision‐Making Process

In the field of eye tracking, scanpath analysis can reflect the sequential and temporal properties of the cognitive process. However, the advantages of scanpath analysis have not yet been utilized in the study of risky decision making. We explored the methodological applicability of scanpath analysis to test models of risky decision making by analyzing published data from the eye‐tracking studies of Su et al. (2013); Wang and Li (2012), and Sun, Rao, Zhou, and Li (2014). These studies used a proportion task, an outcome‐matched presentation condition, and a multiple‐play condition as the baseline for comparison with information search and processing in the risky decision‐making condition. We found that (i) the similarity scores of the intra‐conditions were significantly higher than those of the inter‐condition; (ii) the scanpaths of the two conditions were separable; and (iii) based on an inspection of typical trials, the patterns of the scanpaths differed between the two conditions. These findings suggest that scanpath analysis is reliable and valid for examining the process of risky decision making. In line with the findings of the three original studies, our results indicate that risky decision making is unlikely to be based on a weighting and summing process, as hypothesized by the family of expectation models. The findings highlight a new methodological direction for research on decision making. Copyright © 2016 John Wiley & Sons, Ltd.     

Using an abbreviated assessment to identify effective error‐correction procedures for individual learners during discrete‐trial instruction

Previous research comparing the effectiveness of error‐correction procedures has involved lengthy assessments that may not be practical in applied settings. We used an abbreviated assessment to compare the effectiveness of five error‐correction procedures for four children with autism spectrum disorder or a developmental delay. During the abbreviated assessment, we sampled participants' responding with each procedure and completed the assessment before participants reached our mastery criterion. Then, we used the results of the abbreviated assessment to predict the most efficient procedure for each participant. Next, we conducted validation assessments, comparing the number of sessions, trials, and time required for participants to master targets with each procedure. Results showed correspondence between the abbreviated assessment and validation assessments for two of four participants and partial correspondence for the other two participants. Findings suggest that a brief assessment may be a useful tool for identifying the most efficient error‐correction procedure for individual learners.