Behavioral Interventions Research Articles

A Digital Depression Treatment Program for Adults Treated in Primary Care: A Randomized Clinical Trial.

More than two-thirds of US adults who screen positive for depression in the primary care setting do not receive treatment. These adults need evidence-based and scalable interventions. To determine the effectiveness of Moodivate, a self-directed digital intervention for mental health, in treating depression symptoms among patients in the primary care setting. This 3-group decentralized randomized clinical trial recruited participants from September 22, 2021, to December 27, 2023, and completed data collection on March 29, 2024. Adult patients with at least moderate symptoms of depression on the Patient Health Questionnaire-9 (score ≥10) were enrolled from 22 primary care clinics in South Carolina. Participants received Moodivate (a digital behavioral activation intervention), Moodivate with health care provider access to information on patient use of the digital behavioral activation intervention in the electronic health record (EHR), or usual care for depression. The primary outcome was a change in depression symptoms on the Beck Depression Inventory-II (BDI-II) over 12 weeks. Secondary outcomes included a clinically significant improvement in depression symptoms on the BDI-II (10-point decrease in score), depression remission on the BDI-II (score ≤13), digital behavioral activation intervention engagement, and primary care provider (a physician or other health care professional who is responsible for a patient's primary care) use of the EHR features. Among 649 participants, 495 (76%) were female and the mean (SD) age was 44.68 (15.22) years. Participants who received the digital behavioral activation intervention, with and without EHR integration, had significantly improved depression symptoms vs those who received usual care over 12 weeks (least squares mean change from baseline for Moodivate: -10.34; SE = 0.82; d = 0.98; Moodivate with EHR: -9.88; SE = 0.81; d = 0.93; usual care: -5.94; SE = -0.80; d = 0.54). Participants in the Moodivate groups had 2.5 to 3.0 times higher odds of having a clinically significant improvement in depression symptoms (Moodivate: OR, 2.98 [97.5% CI, 1.69-5.27]; P < .001; Moodivate with EHR: OR, 2.53 [97.5% CI, 1.45-4.41]; P < .001) and 2.3 to 2.6 times higher odds of experiencing depression remission (Moodivate: OR, 2.27 [97.5% CI, 1.16-4.44; P = .006; Moodivate with EHR: OR, 2.63 [97.5% CI, 1.38-5.04]; P < .001) than participants who received usual care. Participant engagement with Moodivate was high in the first month (68% to 100% weekly retention), and 33% of patients continued to use the digital behavioral activation intervention after 12 weeks. Fourteen percent of primary care providers who received access used the EHR functionality. This randomized clinical trial found that a digital behavioral activation intervention is effective for treating adults with at least moderate symptoms of depression in the primary care setting. ClinicalTrials.gov Identifier: NCT04463914.

Addressing Phonological Deficit in Primary Progressive Aphasia With Behavioral Intervention and Transcranial Direct Current Stimulation.

Despite recognition of the underlying phonological impairment observed in the logopenic and nonfluent variants of primary progressive aphasia (PPA), there is relatively little treatment research directed toward strengthening phonological skills. In this study, we focused on remediating phonological deficits in logopenic and nonfluent PPA. Specifically, we hypothesized that behavioral intervention intended to strengthen phonological manipulation skills and sound-letter correspondences-coupled with transcranial direct current stimulation (tDCS)-would improve language abilities, especially in the written modality. Twelve individuals with logopenic or nonfluent variants of PPA and 24 neurotypical adults completed neuropsychological assessment that documented spoken and written language deficits in those with PPA. Phonological skills were consistently impaired in relation to other language processes. Following a double-blind, crossover design, six individuals with PPA were randomized to receive active tDCS with phonological intervention during the first treatment phase, and after a 2-month break, they received a second phase of behavioral intervention paired with sham tDCS. The other six individuals were randomized to receive sham first and active tDCS second. Language skills were evaluated before and after each treatment phase and 2 months after the intervention. Both treatment groups (tDCS-first and sham-first) made significant improvement in phonological transcoding skills in response to behavioral intervention, but those who received active tDCS first showed stronger gains in phonological manipulation ability. This group also showed positive changes in written narratives, which contained more grammatical sentences with increased meaningful content and more accurate spelling. These data provide compelling evidence supporting an approach that targets phonological deficits in logopenic and nonfluent PPA. Specifically, we found that improved phonological skills resulted in better functional communication ability (text-level writing) relevant to everyday life. Positive outcomes were strongest when tDCS was combined with behavioral treatment from the beginning, suggesting that this combination may potentiate positive changes that extend beyond the initial stimulation period. https://doi.org/10.23641/asha.28598195.

Efficacy of an internet-based, therapist-guided cognitive behavioral therapy intervention for adolescents and young adults with body dysmorphic disorder: a randomized controlled trial

BackgroundBody dysmorphic disorder (BDD) is particularly prevalent yet highly understudied and undertreated in adolescence. This study evaluates the efficacy of an internet-based, therapist-guided cognitive behavioral therapy (CBT) for adolescents and young adults with BDD compared to supportive online therapy as an active control condition.MethodsIn a single-blind, randomized controlled trial, N = 45 adolescents (aged 15–21 years) of all genders from German-speaking countries were assigned to 12 sessions of internet-based CBT (iCBT) or 12 weeks of supportive online therapy. The primary outcome was change in expert-rated BDD symptom severity from pre- to post-intervention (Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder, BDD-YBOCS). Secondary outcomes included the remission and responder rate, changes in delusionality of appearance beliefs (BABS), self-rated BDD symptom severity (FKS), BDD cognitions (FKDK), quality of life (KINDL-R), and depressive symptoms (PHQ-9) from pre to post and to a 4-week follow-up.ResultsiCBT was more efficient than supportive online therapy on the BDD-YBOCS (p =.002), with a large between-group effect size at post-intervention (Hedges’ g (SE) = 0.93 (0.42)), and on all secondary measures (p <.05), except for depressive symptoms (p =.068). All secondary outcome measures also showed significant improvements from pre to post iCBT, with moderate to large effect sizes, and gains were stable until the 4-week follow-up period. iCBT participants showed higher remission (61.5%) and responder rates (66.7%), compared to controls (0% and 26.7%), but only the difference in remission reached significance.ConclusionThe results indicate the efficacy of internet-based CBT in comparison to an active control condition, thus contributing to the limited intervention research in adolescent BDD and adding a much-needed treatment option. Trial registration: The trial was pre-registered on 2020/06/08 at the German Clinical Trials Register, DRKS00022055.

School-Based Transdisciplinary Teaming to Maximize Behavioral Supports

Abstract In the United States school system, there is an increasing number of students who need behavioral support. Board Certified Behavior Analysts (BCBAs) utilize the science of applied behavior analysis and are uniquely qualified to provide such support. However, for many reasons, BCBAs may not have the knowledge and skills to capitalize on their services in schools, including collaboration skills that can result in goals, intervention procedures, and outcomes that are not socially and ecologically valid. The current article provides a transdisciplinary model of school-based collaboration for BCBAs to maximize the effectiveness of behavioral interventions in schools. Adapted for school-based BCBAs from Boyer and Thompson's (2014) transdisciplinary model, the current model includes the elements of (a) extending BCBAs’ knowledge regarding school systems, (b) establishing rapport with team members, (c) enriching team members’ understanding of everyone’s role and expectations, and (d) exchanging feedback and praise.

Managing obesity in children: a clinical practice guideline.

Obesity is a complex, chronic, stigmatized disease whereby abnormal or excess body fat may impair health or increase the risk of medical complications, and can reduce quality of life and shorten lifespan in children and families. We developed this guideline to provide evidence-based recommendations on options for managing pediatric obesity that support shared decision-making among children living with obesity, their families, and their health care providers. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We used the Guidelines International Network principles to manage competing interests. Caregivers, health care providers, and people living with obesity participated throughout the guideline development process, which optimized relevance. We surveyed end users (caregivers, health care providers) to prioritize health outcomes, completed 3 scoping reviews (2 on minimal important difference estimates; 1 on clinical assessment), performed 1 systematic review to characterize families' values and preferences, and conducted 3 systematic reviews and meta-analyses to examine the benefits and harms of behavioural and psychological, pharmacologic, and surgical interventions for managing obesity in children. Guideline panellists developed recommendations focused on an individualized approach to care by using the GRADE evidence-to-decision framework, incorporating values and preferences of children living with obesity and their caregivers. Our guideline includes 10 recommendations and 9 good practice statements for managing obesity in children. Managing pediatric obesity should be guided by a comprehensive child and family assessment based on our good practice statements. Behavioural and psychological interventions, particularly multicomponent interventions (strong recommendation, very low to moderate certainty), should form the foundation of care, with tailored therapy and support using shared decision-making based on the potential benefits, harms, certainty of evidence, and values and preferences of children and families. Pharmacologic and surgical interventions should be considered (conditional recommendation, low to moderate certainty) as therapeutic options based on availability, feasibility, and acceptability, and guided by shared decision-making between health care providers and families. This guideline will support children, families, and health care providers to have informed discussions about the balance of benefits and harms for available obesity management interventions to support value- and preference-sensitive decision-making.

Model predictive control in mHealth: a decision framework for optimised personalised physical activity interventions

A major problem in global health is insufficient physical activity (PA) by individuals, despite its proven benefits. In this paper, Model Predictive Control (MPC) is evaluated as the basis for delivering personalised optimal adaptive behavioural interventions aimed at improving PA (in terms of the number of steps walked per day). Utilising the behavioural framework of Social Cognitive Theory (SCT) expressed as a fluid analogy computational model, a series of diverse control strategies are proposed under different circumstances that provide insights into how MPC can serve as a broad-based framework for delivering PA behavioural interventions. The complexities of measurement and information availability, physical and budgetary constraints, and plant limitations and their impact on decision-making are explored, with the results obtained demonstrating MPC's potential to deliver feasible, personalised, and user-friendly behavioural interventions under conditions involving limited measurements, nonlinearity, and plant-model mismatch.

Embracing Hedonism While Being Young: The Effects of Compulsive Buying, Compulsive Hoarding, and Spendthriftness

ABSTRACTThe primary objective of this study is to provide valuable insights into the trends of hedonism, their consequences, and maladaptive consumer behaviors. This is achieved by a parallel mediation‐based analytical approach that examined the link between hedonism and compulsive buying behavior, incorporating consumer spendthriftness and compulsive hoarding‐acquisition constructs, within a hierarchical framework of value‐attitude‐behavior. The study positions the hedonism‐compulsive buying relationship at the intersection of consumer spendthriftness and compulsive hoarding theories. Furthermore, the conceptual model delves into relationships, with a particular focus on moderation‐mediation effects, specifically gender and education level. A quantitative survey was conducted to explore these research aspects, involving a randomly selected sample of 390 respondents from the Prolific platform. Participants were chosen through a self‐reporting method to represent the youth market sector in the United States, reflecting Western consumer culture. The focus was on Generation Z, aged 17–25, consisting of both men and women. This group was further divided into two subgroups: those still in educational development and those who have graduated and entered adulthood without financial support from their families. Research findings indicated that a hedonic orientation, along with associated spendthriftness, compulsive hoarding, and compulsive buying, is more prevalent among young women than young men. Additionally, results revealed that college students, as opposed to graduates, exhibit a higher hedonic capacity and an increased inclination towards maladaptive spending patterns and hoarding. Hedonism, as the professed personal value, makes college students more susceptible to compulsive buying risks, but indirectly via excessive spending inclinations and irresistible consumer desire centered on accumulation/acquisition. Additionally, a qualitative study consisting of interviews with students and graduates was conducted to explore the underlying factors contributing to maladaptive compulsive buying behaviors. This study expanded on our previous quantitative research, reinforcing the argument that hedonism plays a significant role in driving consumer spendthrift behavior, excessive hoarding, and compulsive buying, particularly among students, rather than graduates. Finally, the insights gained from the study helped us understand the development of consumer hedonism, enabling us to suggest effective behavioral interventions and social policies to address these issues among younger consumers.

Narcolepsy Beyond Medication: A Scoping Review of Psychological and Behavioral Interventions for Patients with Narcolepsy

Objectives: The present scoping review aims to map the existing evidence on psychological and behavioral interventions targeting patients with narcolepsy type 1 and type 2. Methods: A literature search was performed using the databases Scopus, PubMed, and PsycINFO. Studies were included if they (1) employed randomized controlled trials, non-randomized trials, or quasi-experimental studies; (2) were published in English; (3) were published in peer-reviewed journals; (4) examined the impact of psychological interventions on psychopathological (primary outcomes) and narcolepsy-related symptoms (secondary outcomes); and (5) involved patients with a diagnosis of narcolepsy using recognized diagnostic criteria regardless of whether they were receiving pharmacological treatment or were untreated. No restrictions were imposed on the publication date to comprehensively map the available evidence. Data were extracted to address the review aims and presented as a narrative synthesis. Results: The database search yielded six studies. Treatment options for individuals with narcolepsy encompass psychological and behavioral interventions, such as telehealth interventions, meditation/relaxation therapy, and scheduled napping. The primary outcomes were daytime sleepiness, wakefulness maintenance, sleep attacks, the severity of symptoms of narcolepsy, sleep paralysis episodes, depression, and psychological functioning. The secondary outcomes were sleep-problem-related quality of life, sleep inertia, and sleep quality. The psychological and behavioral interventions exhibited variability in terms of the intervention type, personnel involved, number of sessions, and duration. Most of the contributions also lack details regarding the training of professionals and the specifics of the interventions. Additionally, the evidence quality was deemed low based on the Crowe Critical Appraisal Tool. Conclusions: Although the importance of nonpharmacological approaches is well recognized, there is limited evidence to support the efficacy of psychological and behavioral interventions in narcolepsy. This is further complicated by the wide range of psychological and behavioral interventions available.

A randomized controlled trial: Evaluating whether a cognitive behavioral internet-delivered intervention targeting emotion regulation improves health-related quality of life in cancer survivors.

Cancer survivors experience reduced overall health-related quality of life (HRQoL) compared to the general population. This research assesses and compares the efficacy of an emotion-focused (CanCopeMind [CM]) and lifestyle (CanCopeLifestyle [CL]) intervention to improve HRQoL among cancer survivors. This 8-week, internet-delivered, randomized controlled trial compared CM (n = 110) and CL (n = 114) on self-reported HRQoL (range -0.022 = indicating a state akin to dead to 1.0 representing perfect health) at baseline, postintervention, and 3-month follow-up. CM, adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, targeted core emotion regulation skills (understanding emotions, mindfulness, flexible thinking, and changing behaviors). CL, the active control, targeted healthy lifestyle domains (diet, exercise, relaxation, and sleep). HRQoL increased in both groups from baseline to postintervention (CM, p < .001, SMDmedian = 0.54; CL, p < .001, SMDmedian = 0.40), and these improvements were sustained at follow-up (CM, p < .001, SMDmedian = 0.52; CL, p = .005, SMDmedian = 0.33). The difference between each group was not significant at either postintervention (p = .095, SMDmedian = 0.19) or follow-up (p = .081, SMDmedian = 0.23). Subgroup analyses revealed no moderation by cancer stage, treatment type, months since treatment, cancer type or sex. The findings indicate that an accessible, internet-delivered emotion-focused and lifestyle interventions hold promise for improving HRQoL among cancer survivors. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Влияние систем альтернативной и дополнительной коммуникации на коррекцию проблемного поведения и развитие вокальной речи у 10-летнего ребенка с РАС

&lt;p style="text-align: justify;"&gt;&lt;strong&gt;Objectives&lt;/strong&gt;. The effectiveness of typing as an alternative and augmentative communication (AAC) tool for problem behavior management and the development of vocal request skill has been underexplored. This study compares the effects of two alternative communication systems&amp;mdash;the Picture Exchange Communication System (PECS) and typing via a tablet application&amp;mdash;on reducing problem behavior episodes and increasing vocal requests in a child with autism spectrum disorder (ASD).&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;Methods&lt;/strong&gt;. From 2018 to 2020, a problem behavior intervention was implemented for a 10-year-old child with ASD who had difficulties using vocal speech. The primary method used was functional communication training (FCT) combined with an extinction procedure. Two AAC tools were applied sequentially: PECS with reinforcement of vocal requests; Typing requests in a tablet app, also with reinforcement of vocal requests..&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;Results&lt;/strong&gt;. When using the AAC system based on typing, the average percentage of problem behavior relative to all responses (both functional communication and problem behavior) was 12%, compared to 25% when using PECS. The average number of vocal requests per school day was 25.9 when using typing in the app, compared to 8.8 with PECS.&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;C&lt;/strong&gt;&lt;strong&gt;onclusions&lt;/strong&gt;. The acquisition of phrase-typing skills for requests in a specialized app led to greater reductions in problem behavior and a higher frequency of vocal requests compared to PECS. Further research is needed to explore the effectiveness of typing in a tablet app as an AAC tool for problem behavior management and vocal request development in children with ASD and speech impairments. Additionally, a possible mediating relationship should be investigated, where a change in AAC format may lead to an increase in vocal requests, which in turn contributes to a reduction in problem behavior.&lt;/p&gt;

Caregiver behavioral changes mediate the effects of naturalistic developmental behavioral interventions: Combining evidence from three randomized controlled trials.

Naturalistic developmental behavioral interventions target developmentally appropriate skills in young children with autism spectrum disorders using behavioral techniques in naturalistic interactions. Naturalistic developmental behavioral interventions demonstrate strong empirical support and frequently utilize caregiver training of intervention strategies. However, our understanding of the mechanisms of change linked to naturalistic developmental behavioral interventions remains limited. Based on retrospective, secondary data analyses from three previously conducted randomized controlled trials of caregiver-mediated naturalistic developmental behavioral interventions, this study examined the direct effect of intervention on caregiver naturalistic developmental behavioral intervention strategy use and how caregiver changes mediate intervention effects on children's social communication. A total of 419 videos from 229 dyads consisting of autistic children (M = 32.5 months/ages 1-5 years) and caregivers were included in analyses using the masked ratings of the measure of naturalistic developmental behavioral intervention strategy implementation-caregiver changes (MONSI-CC) and brief observation of social communication change (BOSCC-SC). Using longitudinal mediation analyses, we examined the mediation effect of caregiver behavioral changes on children's outcomes. Results demonstrated a significant intervention effect on changes of caregiver naturalistic developmental behavioral intervention strategy use (MONSI-CC) and of changeds of caregiver strategy use (MONSI-CC) on child social communication change (BOSCC-SC) scores, but no overall total effect of intervention on changes of child social communication (BOSCC-SC). This study demonstrates the mediating role of caregiver behavior on the child intervention response, a first step toward better understanding underlying mechanisms in naturalistic developmental behavioral interventions.Lay AbstractNaturalistic developmental behavioral interventions use behavioral techniques in naturalistic interactions and settings. Naturalistic developmental behavioral interventions also teach caregivers to use strategies to enhance social communication in their children with autism spectrum disorder. Naturalistic developmental behavioral interventions are effective in supporting young autistic children but how naturalistic developmental behavioral interventions work ("underlying mechanisms") is not known yet. Therefore, by applying new instruments to videos already collected from the three previously conducted randomized controlled trials of caregiver-mediated naturalistic developmental behavioral interventions, we examined how caregivers change in their strategy use over the course of intervention and how that relates to changes in social communication in their autistic children. A total of 419 videos from 229 dyads consisting of autistic children (M = 32.5 months/ages 1-5 years) and caregivers were included in analyses using two measures, one for the caregiver behavioral changes (the measure of naturalistic developmental behavioral intervention strategy implementation-caregiver changes [MONSI-CC]), and another for the children's social communication (the brief observation of social communication change [BOSCC-SC]). We found that naturalistic developmental behavioral interventions were effective in leading to increased mastery of caregiver naturalistic developmental behavioral intervention strategy use, which then affected the changes in child's social communication skills. However, we found no direct effect of treatment for child social communication skills. This study highlights the mediating role of caregiver behavior on the child intervention response, supporting the importance of involving caregivers as partners in the intervention for young autistic children.

A Novel Just-in-Time Intervention for Promoting Safer Drinking Among College Students: App Testing Across 2 Independent Pre-Post Trials.

Binge drinking, which is linked to various immediate and long-term negative outcomes, is highly prevalent among US college students. Behavioral interventions delivered via mobile phones have a strong potential to help decrease the hazardous effects of binge drinking by promoting safer drinking behaviors. This study aims to evaluate the preliminary efficacy of bhoos, a novel smartphone app designed to promote safer drinking behaviors among US college students. The app offers on-demand educational content about safer alcohol use, provides dynamic feedback as users log their alcohol consumption, and includes an interactive drink tracker that estimates blood alcohol content in real time. The bhoos app was tested in 2 independent pre-post studies each lasting 4 weeks, among US college students aged 18-35 years. The primary outcome in both trials was students' self-reported confidence in using protective behavioral strategies related to drinking, with self-reported frequency of alcohol consumption over the past month examined as a secondary outcome. In study 1, bhoos was associated with increased confidence in using protective behavioral strategies. Students also endorsed the high usability of the app and reported acceptable levels of engagement. Study 2 replicated findings of increased confidence in using protective behavioral strategies, and demonstrated a reduction in the self-reported frequency of alcohol consumption. Bhoos is a personalized, accessible, and highly scalable digital intervention with a strong potential to effectively address alcohol-related behaviors on college campuses.

North Carolina Healthy Active Living: Describing a Wellness Coaching Program for First-Episode Psychosis Clinics.

Cardiovascular disease presents a ten-fold higher risk of death than suicide in individuals with serious mental illness. Individuals experiencing first-episode psychosis already have high rates of modifiable risk factors contributing to cardiovascular disease. The initial 12 months are crucial for implementing behavioral interventions for effective risk factor modification and disease prevention. Coordinated Specialty Care (CSC) outpatient clinics provide multi-disciplinary team-based treatment for teens and young adults in the early stages of psychotic illness, significantly improving mental health outcomes and quality of life. However, these clinics lack support for addressing lifestyle behavior changes in their clients. The North Carolina Healthy Active Living (NC HeAL) program is an innovative clinical service offered to all CSC clients in this state. It offers personalized health and wellness coaching to help clients achieve meaningful health improvements. This paper provides a detailed description of the program's development, the target population and setting, the roles and skills of the NC HeAL team, program components and evidence-based program measures. Results of program measures, feasibility, acceptability, implementation, and fidelity will be published separately.

Effectiveness of Token Economy Therapy in Reducing Aggressive Behaviors Among Orphanage Children: A Pilot Study

ABSTRACT Background: Children in orphanages often display aggressive behaviours due to limited personalized care and emotional support. Token economy therapy, which uses positive reinforcement strategies, may offer a promising behavioural intervention in such settings. This pilot study evaluates the effectiveness of token economy therapy in reducing aggression among orphanage children. Methods: A quasi-experimental design was adopted involving 50 children aged 6–12 years from two orphanages in Pune, India. Stratified random sampling ensured balanced representation by age and gender. The intervention consisted of 20 biweekly token economy sessions over 10 weeks, wherein desirable behaviours were rewarded with tokens exchangeable for preferred items. Behavioural assessments were conducted pre- and post-intervention using the Strengths and Difficulties Questionnaire (SDQ). Wilcoxon signed-rank test was used for statistical analysis. Results: Pre-intervention, 76% of children had moderate behavioural difficulties and 24% had severe difficulties. Post-intervention, 36% exhibited normal behaviour and 64% showed only mild difficulties. Mean behavioural scores significantly decreased from 34.42 (±2.64) to 16.34 (±1.72) (Wilcoxon Z = 6.18, P &lt; 0.0001). Improvements were consistent across all academic performance categories. Conclusion: Token economy therapy proved effective in significantly reducing aggressive behaviours among orphanage children. Its structured, reward-based approach may offer a scalable and cost-effective behavioural intervention in institutional care settings. Further studies are warranted to confirm long-term benefits across broader populations.

Determining the feasibility and acceptability of a randomized telehealth pilot study for veterans with chronic multisymptom illness

BackgroundThe shift toward a patient-centered and whole health care model offers a promising approach for the management of symptoms among veterans with chronic multisymptom illness (CMI). A behavioral intervention aimed at reducing cognitive control dysregulation which is a component of impairments common among veterans with CMI may be helpful. Therefore, a pilot study was conducted to explore the feasibility, safety, and acceptability of a telehealth mental and physical (MAP) training intervention among veterans with CMI.MethodsUtilizing a two-arm randomized trial, participants were either randomized to 8 weeks of a directed MAP training protocol (dMAP) that received weekly guidance via text messaging or 8 weeks of self-guided MAP training (sgMAP) which did not receive guidance aside from the intervention goals. The MAP intervention was the same for both groups except for the delivery and consisted of two MAP training sessions and one telephone health coaching session per week. The primary aim of the study was to evaluate the feasibility (e.g., recruitment, retention, and adherence rates; amount of missing data), safety (e.g., adverse events), and acceptability (e.g., satisfaction) of a telehealth MAP intervention.ResultsOut of 44 potentially eligible veterans, 26 were randomized to either the dMAP group (n = 13) or the sgMAP group (n = 13), resulting in a recruitment rate of 59% (26/44 patients). Two participants withdrew after randomization, resulting in 24 participants used for analyses. The retention rates at endpoint and 3-month follow-up were 79.2% (19/24; dMAP:sgMAP = 9:10) and 62.5% (15/24; dMAP:sgMAP = 7:8), respectively. Participants completed an average of 48.2% of the MAP sessions (7.7/16 sessions; dMAP:sgMAP = 7.9:7.5 sessions) and 82.8% of the health coaching sessions (6.6/8 sessions; dMAP:sgMAP = 7.2:6.2 sessions). Missing data was minimal, and no adverse events related to the study were reported. Acceptability was high as veterans were satisfied with the wearables and valued the health coaching support.ConclusionsThis pilot study provides insights into the feasibility of a large-scale randomized control trial that promotes meditation and physical activity to augment cognitive control to facilitate self-regulation. Future efforts should expand recruitment strategies and add internal data quality monitoring.Trial registrationNCT04164667, retrospectively registered November 12, 2019, https://clinicaltrials.gov/study/NCT04164667

Mitigating impacts of food production and consumption on climate change: Applications of behavioral economics

AbstractFood consumption and production have been identified as significant contributors to greenhouse gas emissions. Individual and producer behaviors are critical in making emission‐reducing consumption choices and implementing agricultural conservation practices. Using a narrative review approach, this research examined over 100 publications and evaluated behavioral and experimental interventions in consumers' food choices and producers' agricultural conservation decisions. We identify several areas where there is mixed evidence and knowledge gaps. We evaluate these gaps using a framework we devised called CREDIBLE. This systematic framework provides a practical checklist for policymakers and academics to evaluate if their interventions meet critical factors before rolling out large‐scale behavioral interventions. The main criteria to evaluate interventions, as proposed by our framework, are as follows: cost‐effectiveness, replicability, evidence‐based, durability, identity‐respecting, boomerang minimizing, logistical feasibility, and respect for ethics.

Impact of Multifaceted Interventions Including Waterless Patient Care on Endemic Occurrence of Serratia marcescens in an Intensive Care Unit

Serratia marcescens acquisition is a common problem in intensive care units (ICUs). Following an initial outbreak in 2017 with ongoing endemicity, this study aimed to analyze the impact of behavioral interventions and sink removals on S. marcescens incidence in a tertiary-care ICU. We conducted a quasi-experimental, interventional study including patients with a positive screening or clinical culture for S. marcescens, from 48 h (D2) after ICU admission to 14 days after ICU discharge. A sub-analysis considered patients positive for S. marcescens from ICU admission (D0) to 14 days after ICU discharge. Multivariate Poisson regression analyses were performed. Between January 2014 and December 2022, 167 cases of S. marcescens infection or colonization were identified (respiratory samples, 71%). Despite the presence of an aquatic reservoir, we found that neither behavioral nor architectural interventions (sink removal) reduced significantly S. marcescens incidence, yielding incidence ratios of 1.02 [95%CI 0.33–3.11] and 4.25 [95%CI 0.59–30.56], respectively. However, an association was observed with administration of selective oral decontamination (SOD) in the sub-cohort (OR 1.01; 95%CI 1.00–1.03). Behavioral change interventions and transition to a waterless ICU did not control endemic, polyclonal S. marcescens occurrence. The selective pressure exercised by SOD may have reduced the effectiveness of waterless care.

Developing an Internet-Based Cognitive Behavioral Therapy Intervention for Adolescents With Anxiety Disorders: Design, Usability, and Initial Evaluation of the CoolMinds Intervention.

Digital mental health interventions may help increase access to psychological treatment for adolescents with anxiety disorders. However, many clinical evaluations of digital treatments report low adherence and engagement and high dropout rates, which remain challenges when the interventions are implemented in routine care. Involving intended end users in the development process through user-centered design methods may help maximize user engagement and establish the validity of interventions for implementation. This study aimed to describe the methods used to develop a new internet-based cognitive behavioral therapy intervention, CoolMinds, within a user-centered design framework. The development of intervention content progressed in three iterative design phases: (1) identifying needs and design specifications, (2) designing and testing prototypes, and (3) running feasibility tests with end users. In phase 1, a total of 24 adolescents participated in a user involvement workshop exploring their preferences on graphic identity and communication styles as well as their help-seeking behavior. In phase 2, a total of 4 adolescents attended individual usability tests in which they were presented with a prototype of a psychoeducational session and asked to think aloud about their actions on the platform. In phase 3, a total of 7 families from the feasibility trial participated in a semistructured interview about their satisfaction with and initial impressions of the platform and intervention content while in treatment. Activities in all 3 phases were audio recorded, transcribed, and coded using thematic analysis and qualitative description design. The intervention was continuously revised after each phase based on the feedback. In phase 1, adolescent feedback guided the look and feel of the intervention content (ie, color scheme, animation style, and communication style). Participants generally liked content that was relatable and age appropriate and felt motivating. Animations that resembled "humans" received more votes as adolescents could better "identify" themselves with them. Communication should preferably be "supportive" and feel "like a friend" talking to them. Statements including praise-such as "You're well on your way. How are you today?"-received the most votes (12 votes), whereas directive statements such as "Tell us how your day has been?" and "How is practicing your steps going?" received the least votes (2 and 0 votes, respectively). In phase 2, adolescents perceived the platform as intuitive and easy to navigate and the session content as easy to understand but lengthy. In phase 3, families were generally satisfied with the intervention content, emphasizing the helpfulness of graphic material to understand therapeutic content. Their feedback helped identify areas for further improvement, such as editing down the material and including more in-session breaks. Using user involvement practices in the development of interventions helps ensure continued alignment of the intervention with end-user needs and may help establish the validity of the intervention for implementation in routine care practice.

Development of Digital Strategies for Reducing Sedentary Behavior in a Hybrid Office Environment: Modified Delphi Study.

Hybrid work is the new modus operandi for many office workers, leading to more sedentary behavior than office-only working. Given the potential of digital interventions to reduce sedentary behavior and the current lack of studies evaluating these interventions for home office settings, it is crucial to develop digital interventions for such contexts involving all stakeholders. This study aimed to reach expert consensus on the most feasible work strategies and the most usable digital elements as a delivery method to reduce sedentary behavior in the home office context. A modified Delphi study including 3 survey rounds and focus groups was conducted to achieve consensus. The first Delphi round consisted of two 9-point Likert scales for assessing the feasibility of work strategies and the potential usefulness of digital elements to deliver the strategies. The work strategies were identified and selected from a scoping review, a systematic review, and 2 qualitative studies involving managers and employees. The median and mean absolute deviation from the median for each item are reported. The second round involved 2 ranking lists with the highly feasible strategies and highly useful digital elements based on round 1 responses to order the list according to experts' preferences. The weighted average ranking for each item was calculated to determine the most highly ranked work strategies and digital elements. The third round encompassed work strategies with a weight above the median from round 2 to be matched with the most useful digital elements to implement each strategy. In total, 4 focus groups were additionally conducted to gain a greater understanding of the findings from the Delphi phase. Focus groups were analyzed using the principles of reflexive thematic analysis. A total of 27 international experts in the field of occupational health participated in the first round, with response rates of 86% (25/29) and 66% (19/29) in rounds 2 and 3, respectively, and 52% (15/29) in the focus groups. Consensus was achieved on 18 work strategies and 16 digital elements. Feedback on activity progress and goal achievement; creating an action plan; and standing while reading, answering phone calls, or conducting videoconferences were the most feasible work strategies, whereas wrist-based activity trackers, a combination of media, and app interfaces in smartphones were the most useful digital elements. Moreover, experts highlighted the requirement of combining multiple levels of strategies, such as social support, physical environment, and individual strategies, to enhance their implementation and effectiveness in reducing sedentary behavior when working from home. This expert consensus provided a foundation for developing digital interventions for sedentary behavior in home office workers. Ongoing interventions should enable the evaluation of feasible strategies delivered via useful digital elements in home office or hybrid contexts.

Behavioral parenting intervention for parents of preschool-aged children born moderately and late preterm: An experimental study.

Behavioral parenting intervention for parents of preschool-aged children born moderately and late preterm: An experimental study.