Behavioral Approach Research Articles

Effectiveness of a Group Counseling Intervention for Turkish University Students with Childhood Trauma

This research aimed to examine the effects of an eclectic group counseling intervention based on the cognitive and behavioral counseling approach and positive psychology-based practices on the rumination and life satisfaction levels of university students with childhood trauma in Turkey. The research was designed as an exploratory sequential mixed-method study. The first phase of the research focused on discovering what university students with traumatic stories needed to reduce their rumination levels and increase their life satisfaction. The themes that were obtained contributed to the content of the program. In the second phase, forty-two participants were randomly assigned to the experimental and control groups. The Rumination Scale and the Satisfaction with Life Scale were applied as data collection tools. A 12-session group psychological counseling program was provided once a week to the experimental group. No intervention was made in the control group. One week after the sessions were completed, the posttest was administered to the experimental and control groups, and follow-up measurements were carried out two months later. The participants in the experimental group showed significant improvements in decreasing rumination levels and increasing life satisfaction compared to the participants in the control group, and these improvements were maintained in the follow-up measurements. In the last phase, the qualitative data collected during the sessions were analyzed to evaluate the program. In conclusion, the group counseling intervention was effective in reducing the rumination levels and increasing the life satisfaction levels of university students.

A multilevel examination of an inhibitory retrieval approach to exposure: Differentiating the unique and combined effects of multiple-context and multiple-stimulus cues

Background and objectivesA proposed strategy for attenuating the return of fear is conducting exposure therapy in multiple contexts (e.g., different locations), which is believed to enhance the generalizability of safety learning. Although conducting exposure in multiple contexts can be differentiated from conducting exposure with multiple stimuli, the two strategies are often conflated. Furthermore, researchers have not yet determined whether one of these strategies, or a combination thereof, is most effective in attenuating fear renewal. MethodsAccordingly, the present treatment-analogue study examined the unique and combined effects of multiple-context and multiple-stimulus imagery-based exposure manipulations on threat expectancy, behavioral approach/anxiety, and attentional bias for threat over Zoom. Community adults (N = 134) who met diagnostic criteria for snake phobia were randomized to exposure to a single snake in multiple environmental contexts (MC), exposure to multiple snakes in a single environmental context (MS), or exposure to multiple snakes in multiple environmental contexts (MS/MC). ResultsResults revealed significant reductions in threat expectancy and behavioral anxiety, but not attentional bias for threat in all three groups. However, behavioral approach declined over the course of exposure in the MS/MC condition but remained stable in the MC and MS conditions. There were no significant group differences in behavioral approach/anxiety or attentional bias at a one-week follow-up. However, participants in the MC condition reported lower threat expectancy at a one-week follow-up than the other groups and this group difference was partially mediated by lower mean distress during exposure. ConclusionsImplications of these findings for the inhibitory retrieval theory are discussed.

Developmental Cajal-Retzius cell death contributes to the maturation of layer 1 cortical inhibition and somatosensory processing

The role of developmental cell death in the formation of brain circuits is not well understood. Cajal-Retzius cells constitute a major transient neuronal population in the mammalian neocortex, which largely disappears at the time of postnatal somatosensory maturation. In this study, we used mouse genetics, anatomical, functional, and behavioral approaches to explore the impact of the early postnatal death of Cajal-Retzius cells in the maturation of the cortical circuit. We find that before their death, Cajal-Retzius cells mainly receive inputs from layer 1 neurons, which can only develop their mature connectivity onto layer 2/3 pyramidal cells after Cajal-Retzius cells disappear. This developmental connectivity progression from layer 1 GABAergic to layer 2/3 pyramidal cells regulates sensory-driven inhibition within, and more so, across cortical columns. Here we show that Cajal-Retzius cell death prevention leads to layer 2/3 hyper-excitability, delayed learning and reduced performance in a multi-whisker-dependent texture discrimination task.

Monetary reward enhances response inhibition processes manifested in No-go P3

This study investigated the impact of motivational valence on No-go P3 and N2 by incorporating monetary rewards based on response outcomes. We also investigated how personality differences in terms of the behavioral inhibition system (BIS) and behavioral approach system (BAS) influenced No-go N2 and No-go P3. Twenty-eight participants performed Go/No-go tasks (80 % Go and 20 % No-go) under two conditions. In the reward condition, each correct-rejection trial for the No-go stimulus was rewarded with 10 yen (∼6 cents), whereas in the neutral condition, neither monetary rewards nor punishments were contingent on response outcomes. Individual responsiveness to punishment and rewards was evaluated using the BIS and BAS scales. The error rate was significantly lower in the reward condition than in the neutral condition. P3 amplitude for correct-rejection trials (i.e., preceding erroneous muscular activity on the wrong hand) was larger in the reward condition than in the neutral condition; however, N2 amplitudes did not differ between the two conditions. These results suggest that monetary rewards may enhance motor inhibition control. Individuals with a higher BIS score exhibited a larger No-go N2 for correct-rejection in the neutral condition. We conclude that No-go N2 amplitude is modulated by avoidance motivation.

Bibliometric Exploration of Consumer Behavior towards Sustainable Products

This research provides a comprehensive bibliometric analysis of consumer behavior towards sustainable products, examining key themes, research trends, and author collaboration networks from 1971 to 2024. The study identifies central themes such as consumer behavior, food and organic products, planned behavior, consumer perception, and strategic approaches, with a notable emphasis on the role of social media. Research trends indicate a significant focus on the food sector, particularly organic products, and a consistent interest in understanding the psychological and social factors driving sustainable consumption. The analysis also highlights potential future research areas, including deepening the understanding of consumer behavior, enhancing consumer perceptions, leveraging social media for sustainability promotion, and developing effective strategic interventions. The author collaboration network reveals strong co-authorship ties within distinct clusters of researchers, suggesting the need for increased cross-collaboration to enhance the field's breadth and impact. This study offers valuable insights for researchers, practitioners, and policymakers aiming to promote sustainable consumer behaviors and develop effective strategies for sustainability.

Type 2 Diabetes Mellitus and Cardiometabolic Prospects: A Rapid Narrative Review.

Cardiometabolic syndrome (CMS), type 2 diabetes mellitus (T2DM), and cardiovascular diseases are among the major altruists to the international liability of disease. The lifestyle and dietary changes attributable to economic growth have resulted in an epidemiological transition towards non-communicable diseases (NCDs) as the leading causes of death. Low- and middle-income countries (LMICs) bear a more substantial disease burden due to limited healthcare sector capacities to address the rapidly growing number of chronic disease patients. The purpose of this narrative review paper was to explore the interrelationships between CMS, T2DM, and cardiovascular impairments in the context of NCDs, as well as major preventative and control interventions. The role of insulin resistance, hyperglycemia, and dyslipidemia in the pathogenesis of T2DM and the development of severe cardiovascular impairments was highlighted. This paper elaborated on the pivotal role of lifestyle modifications, such as healthy diets and physical activity, as cornerstones of addressing the epidemics of metabolic diseases. Foods high in calories, refined sugar, red meat, and processed and ready-to-eat meals were associated with an amplified risk of CMS and T2DM. In contrast, diets based on fruits, legumes, vegetables, and whole grain, home-cooked foods demonstrated protective effects against metabolic diseases. Additionally, the role of a psychological and behavioral approach in addressing metabolic diseases was highlighted, especially regarding its impact on patient empowerment and the patient-centered approach to preventative and therapeutic interventions.

Behavioral Approach Through Assertive Training in Improving Interpersonal Communication Skills of Students: A Systematic Literature Review

First-year students encounter new and latest things that they might not have gotten before entering college. One of the main concerns is interpersonal communication skills, which are either mandatory or simply necessary for them to know in order to communicate in the campus environment. Interpersonal skills have many benefits, including making them more confident, able to speak in public, accepting of themselves, and able to build healthy relationships with others. Various types of bullying that occur in the environments of students and college students are influenced by many factors, including low self-acceptance. This can make them less accepting of themselves, unable to accept rejection or criticism, and even closed off to others. Therefore, the researcher wanted to find literature sources related to how to improve interpersonal communication skills through assertive training in 2023. The method used was systematic literature review (SLR). The results show that assertive training for students can improve interpersonal communication skills.

Tumato 2.0 - a constraint-based planning approach for safe and robust robot behavior

Tumato 2.0 - a constraint-based planning approach for safe and robust robot behavior

The social force model: a behavioral modeling approach for information propagation during significant events

Information diffusion otherwise known as the propagation, spread or dissemination of information occurs when a piece of information flows from a particular individual/community to another in a social network. Studies related to information propagation involve problems regarding the factors that affect the information propagation, how the information is disseminated, the speed of propagation, etc. Researchers have proposed information propagation models to understand the phenomenon and to answer these questions. These models have been effectively used in applications such as behavior analysis, public health care, etc. Although several studies are carried out in this field, the literature demands identifying the most influential factors of propagation in real time in cases of sudden unexpected significant disasters/epidemics/pandemics, since the existing propagation models seem unfit during such circumstances. In this paper, a novel information propagation model which predicts the top propagators of information related to a particular context is proposed. This model utilizes the past few weeks' data during a sudden outbreak of a disaster and identifies the most influential attributes of a user profile to predict the top propagators of the future. The proposed Social Force Model is inspired by a model used in studying the fear propagation pattern in pedestrian dynamics in real-life situation [Cornes FE, Frank GA, Dorso CO. Fear propagation and the evacuation dynamics. Simul Model Pract Theory. 2019;95:112–133.]. We have effectively mapped the various forces which constitute the Social Force Model such as the Desired Force, the Social Force and the Granular Force with respect to the online social network context in order to discover the key spreaders of information during a specific context. Apart from identifying the propagators, the proposed model discovers the key attributes by analyzing the behavior of users based on their past activities in the online social network.

Behavioral Therapy in Post Menopause Patients with Urine Incontinence Problems – Systematic Review

A journal search was carried out used the keywords "Postmenopausal women AND Cognitive Behavioral therapy AND urinary incontinence AND meta analysis" to collect relevant articles published in the last 10 years from five databases (ProQuest, PubMed, Science Direct, Ebsco and Google Scholar. Criteria inclusions were: nurses, patients, urinary incontinence, intervention, full text articles, studies that focused on nursing assessment, and written in English. Six journal articles were selected and analyzed using PICO. Results, Non-pharmacological therapy with a behavioral therapy approach with the application of MBSR (Mindfulness based stress reduction) and HEP (Health Enhancement program) as well as Yoga Therapy & PFMT (Pelvic Floor Muscle Training) exercises combined with light physical exercise such as walking, cycling, swimming. for 30 minutes as well as diet modifications can help postmenopausal patients with urinary incontinence. Conclusion: The application of MBSR (Mindfulness based stress reduction) and HEP (Health Enhancement program) as well as Yoga Therapy & PFMT (Pelvic Floor Muscle Training) exercises combined with light physical exercise such as walking, cycling, swimming for 30 minutes and diet modification can reduces the number of episodes of urine leakage and improves all types of urinary incontinence problems as well as quality of life and can be beneficial for sexual function in post menopausal women.

Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study: study protocol for a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes

BackgroundThe Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study is a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes (T2D). The study aims to test the efficacy of a personalized behavioral approach for dietary management of moderately controlled T2D, versus a standardized behavioral intervention that uses one-size-fits-all dietary recommendations, versus a usual care control (UCC). The primary outcome will compare the impact of each intervention on the mean amplitude of glycemic excursions (MAGE).MethodsEligible participants are between 21 and 80 years of age diagnosed with moderately controlled T2D (HbA1c: 6.0 to 8.0%) and managed on lifestyle alone or lifestyle plus metformin. Participants must be willing and able to attend virtual counseling sessions and log meals into a dietary tracking smartphone application (DayTwo), and wear a continuous glucose monitor (CGM) for up to 12 days. Participants are randomized with equal allocation (n = 255, n = 85 per arm) to one of three arms: (1) Personalized, (2) Standardized, or (3) UCC. Measurements occur at 0 (baseline), 3, and 6 months. All participants receive isocaloric energy and macronutrient targets to meet Mediterranean diet guidelines, in addition to 14 intervention contacts over 6 months (4 weekly then 10 biweekly) to cover diabetes self-management education. The first 4 UCC intervention contacts are delivered via synchronous videoconferences followed by educational video links. Participants in Standardized receive the same educational content as those in the UCC arm, following the same schedule. However, all intervention contacts are conducted via synchronous videoconferences, paired with Social Cognitive Theory (SCT)-based behavioral counseling, plus dietary self-monitoring of planned meals using a mobile app that provides real-time feedback on calories and macronutrients. Participants in the Personalized arm receive all elements of the Standardized intervention, in addition to real-time feedback on predicted post-prandial glycemic response (PPGR) to meals and snacks logged into the mobile app.DiscussionThe DiaTeleMed Study aims to address an important gap in the current landscape of precision nutrition by determining the contributions of behavioral counseling and personalized nutrition recommendations on glycemic control in individuals with T2D. The fully remote methodology of the study allows for scalability and innovative delivery of personalized dietary recommendations at a population level.Trial registrationClinicalTrials.gov NCT05046886. Registered on September 16, 2021.

Penerapan konseling kelompok dengan pendekatan behavioral untuk meningkatkan kemampuan prestasi belajar siswa madrasah tsanawiyah

This research aims to find out how to apply group counseling with a behavioral approach to improve the learning achievement abilities of class VII students at MTS TPI Medan. This research uses quantitative. The method used in this research is one group pre-test and post-test design. The population in this study was all 60 class VII students. The research sample consisted of 9 students. The data collection tool is a learning achievement questionnaire whose validity has been tested using SPSS 29.0. From the results of the t test in the form of a paired sample test, learning achievement ability is in the high category with an average value (mean) of 16.88889 and also shows that there is a significant value of <.001, meaning less than 0.05, it can be concluded that H0 is rejected. So it can be said that there is a significant difference between learning achievement abilities before and after implementing group counseling with a behavioral approach.

Sarung dan Celana Panjang di Komunitas Nahdlatul Ulama: Perspektif Theory of Planned Behavior

Communication is an important aspect in every organization. Both between leaders and subordinates and vice versa, as well as from fellow members of the organization. The relationship between communication and organizational science is seen in how each individual influences the achievement of organizational goals. Nahdlatul Ulama as the largest community organization in Indonesia, requires good organizational communication in disseminating information to all levels of the organization. The aim of this research is to explain and analyze the statement by Gus Yahya as General Chair of PBNU regarding sarongs and trousers towards Syuriyah and Tanfidziyah ranks, which has an impact on the understanding of NU administrators in interpreting this statement. The research method used is descriptive qualitative, with analysis using the Theory of Planned Behavior approach, proposed by Icek Ajzen. The data collection techniques used in this research were interviews, observation, documentation and questionnaires. The results of this research, namely that the NU management interpreted Gus Yahya's statement as a distinction between Syuriyah and Tanfidziyah administrators, where Syuriyah is the highest leader of NU and Tanfidziyah is the executive of the organization.

Social Story Intervention for Training Expected Behaviors among Preschool Children: A Systematic Review and Meta-Analysis.

Promoting appropriate behaviors in early childhood is crucial for children's future development. This systematic review aimed to explore the efficacy of social story (SS) intervention in teaching expected behaviors among preschool children. A structured search strategy was applied to five online electronic databases. The references were systematically screened in accordance with the PRISMA statements. Randomized or non-randomized controlled studies, as well as single-subject studies, in which SSs served as a behavioral training approach for children aged 2 to 6 years were included. Information related to study design, characteristics of the participants, target behaviors, and implementation of SS intervention was extracted. A meta-analysis was performed using the random-effects model, where similar outcomes were evaluated by similar intervention across multiple studies. Twenty-one studies were identified for qualitative analysis, while two studies formed the basis of the meta-analysis. SS interventions were employed to teach a variety of behaviors among typically developing children as well as those with various disabilities, such as autism, developmental delay, hearing impairments, attention deficit hyperactivity disorder, or other disabilities. The target behaviors included oral health practices, peer interaction, staying on-task, self-regulation, sleep habits, and controlling aggressive behavior during group activities. The SSs were used either alone or combined with other strategies, such as positive reinforcement, music therapy, role play, group discussion, video self-modeling, immediate practices, or additional audio commentary. Most studies reported improvements in appropriate behaviors and/or reductions in unfavorable behaviors. The meta-analysis indicated that children practiced more toothbrushing steps when using SS interventions compared to conventional oral health instruction (Z = 3.60, MD = 0.66, 95%CI 0.30 to 1.02, p < 0.001). SS interventions have the potential to teach target behaviors, particularly toothbrushing behaviors, among preschool children. More well-designed randomized controlled trials are warranted to determine the efficacy of SS interventions among children with various developmental profiles.

Sex differences in the social motivation of rats: Insights from social operant conditioning, behavioural economics, and video tracking

BackgroundSocial behaviour plays a key role in mental health and wellbeing, and developing greater understanding of mechanisms underlying social interaction—particularly social motivation—holds substantial transdiagnostic impact. Common rodent behavioural assays used to assess social behaviour are limited in their assessment of social motivation, whereas the social operant conditioning model can provide unique and valuable insights into social motivation. Further characterisation of common experimental parameters that may influence social motivation within the social operant model, as well as complementary methodological and analytical approaches, are warranted.MethodsThis study investigated the effects of biological sex, housing condition, and time-of-day, on social motivation using the social operant model. This involved training rats to lever press (FR1) for 60-s access to a social reward (same-sex conspecific stimulus). Subjects were male and female Wistar rats, housed under individual or paired conditions, and sessions were conducted either in the mid-late light phase (ZT6-10) or early-mid dark phase (ZT13-17). A behavioural economics approach was implemented to measure social demand and the influence of stimulus partner sex (same- vs. opposite-sex stimulus) on social operant responding. Additionally, video tracking analyses were conducted to assess the degree of convergence between social appetitive and consummatory behaviours.ResultsBiological sex, housing conditions, the interaction between sex and housing, and stimulus partner sex potently influenced social motivation, whereas time-of-day did not. Behavioural economics demonstrated that sex, housing, and their interaction influence both the hedonic set-point and elasticity of social demand. Video analysis of social interaction during social operant sessions revealed that social appetitive and consummatory behaviours are not necessarily convergent, and indicate potential social satiety. Lastly, oestrus phase of female experimental and stimulus rats did not impact social motivation within the model.ConclusionsSocial isolation-dependent sex differences exist in social motivation for rats, as assessed by social operant conditioning. The social operant model represents an optimal preclinical assay that comprehensively evaluates social motivation and offers a platform for future investigations of neurobiological mechanisms underlying sex differences in social motivation. These findings highlight the importance of continued consideration and inclusion of sex as a biological variable in future social operant conditioning studies.Plain English summaryHumans are social creatures—our everyday interactions with others and the support this provides play a key role in our wellbeing. For those experiencing mental health conditions, people’s motivation to engage with others can wane, which can lead them to withdraw from those who support them. Therefore, to develop better treatment strategies for these conditions, we need to gain a deeper understanding of social motivation. Studying social behaviour in animals can facilitate this investigation of social motivation as it allows for a causal understanding of underlying neurobiology that is not possible in human experiments. An optimal way to study social motivation in animals is using the social operant conditioning model, where rats learn to press a lever that opens a door and allows them to interact with another rat for a short time. This study characterised the social operant model by testing whether sex, housing conditions, time-of-day, and the sex of the stimulus partner influence rats’ motivation to seek interaction with another rat. We found that female rats were more socially motivated than males, and that rats living alone were more motivated than those living with another rat; interestingly, this effect of housing affected females more than males. Regardless of sex, rats were more motivated to interact with a rat of the opposite sex. These findings provide insights into sex differences in social motivation in rats and new insights into the social operant model which will help guide future research into social motivation and other mental health conditions.

Keep me posted, but don’t stress me out: how the positive effect of social networking services on civil servants’ information use and political capacities can be attenuated by social media stress

Public policy and administration debates typically assume that ICT tools, including social networking services (SNS), increase the amount of information that is communicated and thus harnessed for policymaking processes. At the same time, behavioral approaches point to the potentially detrimental effects of social media stress resulting from an overexposure to SNS. Because systematic research on the individual-level effects of SNS in policy formulation is rare, this paper explores the effect of SNS on the use of policy-relevant information and, thus, on individual political capacities. A moderated mediation analysis was performed based on survey data from central ministerial bureaucracies in Germany, Italy, and Norway, considering not only the amount of information utilized in legislative drafting but also the variability and concentration of the information sources. The results indicate that SNS positively relate to policy officials’ information use, which, in turn, increases their self-reported political capacities. However, the positive relationship between SNS and both the amount and the variability of information use was found to be diminished when levels of social media stress are high rather than low. The conclusions discuss the implications for civil servants and policymaking.

The Effect of Token Economy on Managing Aggression in Adults and Adolescents with Mental Disorders: A Recent Review

Context: Individuals with mental illness may exhibit aggression due to psychological instability. The Token Economy is a behavioral approach that aims to achieve desired changes by using tokens as reinforcements. Objectives: This study investigates the effectiveness of token reinforcement in reducing aggressive behavior in mentally ill patients and identifies the factors that enhance the effectiveness of the Token Economy program. Evidence Acquisition: A search for studies was conducted in the databases of PubMed, Google Scholar, ProQuest, Scopus, and Web of Science using several keywords, including "Contingency Management," "Token Reinforcement," "Token Economy," "behavioral disorder," "mental disorder," "aggression," "violence," "disruptive behavior," and "challenging behavior." The search focused on articles published from 2003 to 2023 that included the implementation of token reinforcement in various settings for managing aggression. Results: A total of 12 studies met the inclusion criteria. After reviewing these studies, several factors were identified as responsible for the program's effectiveness. The Quality Assessment Tool for Quantitative Studies and the Oxford Centre for Evidence-Based Medicine (2011) were used to evaluate the studies. Of the 12 studies, two were rated as strong quality, one as moderate, and nine as weak quality. Additionally, three studies were classified as level 2, one as level 3, and eight as level 4, indicating significant methodological limitations. Conclusions: Generally, 9 studies supported the effectiveness of the Token Economy in managing aggression in adults and adolescents with mental illness. This approach can be useful in the modern rehabilitation and education of individuals with aggressive behavior. We recommend further studies with higher methodological quality to examine the generalizability and transferability of the results.

Stress-induced anxiety-related behavior in mice is driven by enhanced excitability of ventral tegmental area GABA neurons.

Stress and trauma are significant risk factors for many neuropsychiatric disorders and diseases, including anxiety disorders. Stress-induced anxiety symptoms have been attributed to enhanced excitability in circuits controlling fear, anxiety, and aversion. A growing body of evidence has implicated GABAergic neurons of the ventral tegmental area (VTA) in aversion processing and affective behavior. We used an unpredictable footshock (uFS) model, together with electrophysiological and behavioral approaches, to investigate the role of VTA GABA neurons in anxiety-related behavior in mice. One day after a single uFS session, C57BL/6J mice exhibited elevated anxiety-related behavior and VTA GABA neuron excitability. The enhanced excitability of VTA GABA neurons was correlated with increased glutamatergic input and a reduction in postsynaptic signaling mediated via GABAA and GABAB receptors. Chemogenetic activation of VTA GABA neurons was sufficient to increase anxiety-related behavior in stress-naïve mice. In addition, chemogenetic inhibition of VTA GABA neurons suppressed anxiety-related behavior in mice exposed to uFS. These data show that VTA GABA neurons are an early substrate for stress-induced anxiety-related behavior in mice and suggest that approaches mitigating enhanced excitability of VTA GABA neurons may hold promise for the treatment of anxiety provoked by stress and trauma.

Agent-Based Modeling for Household Decision-Making in Adoption of Private Flood Mitigation Measures: The Upper Kan Catchment Case Study

Residential areas in developing arid and semi-arid countries are highly vulnerable to flooding, and water shortages have forced their inhabitants to live close to rivers. While climate change is expected to cause more extreme weather conditions in the future, adopting private loss-reduction measures can diminish flood risk. Although the number of flood models has grown significantly for developing arid and semi-arid lands, these models suffer from being incapable of performing micro-scale flood risk analysis and including household behaviors. This research work presents a novel socio-economic simulation model in the framework of flood risk management (FRM) to couple household adaptive responses with flood risk analysis. Agent-based modeling (ABM) embeds human behaviors in a flood-simulating environment. The focus of this research is the upper Kan catchment in Iran with a long history of severe flash flooding. Our results show the ability of the developed framework to address household participation in FRM activities through private precautionary measures. Moreover, the results indicate the importance of presenting such micro-level behaviors in flood modeling for a more realistic flood risk assessment. It is also demonstrated that household adaptation in a continuous way can lead to less flood risks in the region, even under climate change and the future economy. Finally, the results reveal that the remaining and diminished regional flood risks are influenced by the behavioral framework through which the individuals make decisions in adopting flood-loss-reduction measures. A similar pattern is, however, observed in household contributions over time among the discussed behavioral approaches.

Knowledge of Patients' Activation Level Changes Expert US Physicians' Communication in GERD Management.

Gastroesophageal reflux disease (GERD) is common. Treatment is to manage symptoms, but medication nonadherence is common. To date, little emphasis has been on understanding patient behaviors and reasons for medication nonadherence. We performed a cross-sectional survey study among expert gastroenterologists specializing in esophageal disease. Survey studies consisted of a 6-item questionnaire measuring physician knowledge of patient activation, the Clinician Support for Patient Activation Measure (CS-PAM), and an adapted 20-item Patient Assessment of Chronic Illness Care (PACIC). All question stems were specified to GERD management. Thirty-six experts participated. Most indicated hearing the term patient engagement before this survey (88.9%), but fewer were aware of the term patient activation (33.3%). Respondents were then made aware of the clinical significance of patient activation and asked, based on this knowledge, the likelihood that patients' activation level before the clinic would impact their communication. Responses varied between "to a great extent" and "not at all." Overall, CS-PAM activation scores were high, indicating a high level of support for patient activation. Lastly, respondents indicated their frequency of participating in partnership-building behaviors with patients. More than half (52.8%) of expert physicians "almost always" asked how GERD affected their lives, while less often asked patients about their health habits (22.2%), help set specific goals to improve their eating or exercise lifestyle (19.4%), or refer patients to a dietician, health educator, or counselor for their GERD (11.1%). Patient activation is an important strategy and may provide a behavioral approach to address medication adherence in GERD.