A randomized controlled trial of cognitive debiasing improves assessment and treatment selection for pediatric bipolar disorder.

This study examined the efficacy of a new cognitive debiasing intervention in reducing decision-making errors in the assessment of pediatric bipolar disorder (PBD)

Clinical Decision-Making and Pediatric Bipolar Disorder

Clinical decision-making in mental health could greatly benefit from evidence-based decision tools, particularly in diagnosing challenging, high-stakes conditions such as pediatric bipolar disorder. The current literature indicates that clinicians are prone to a host of cognitive biases that impede optimal diagnostic and treatment decisions. These biases are especially salient in the assessment of bipolar illness. Bipolar disorder is frequently misdiagnosed, and recent evidence suggests that mental health professionals often overdiagnose bipolar in youths. Although actuarial approaches have taken root in the medical community to assess the likelihood of various conditions, the mental health field has not widely disseminated or implemented such strategies. In fact, little research has attempted to validate the clinical utility of actuarial assessment methods. This study examines the effectiveness of an actuarial approach in diagnosing pediatric bipolar disorder by comparing Bayesian estimates (i.e., actuarial approach) to the current gold standard in clinical assessment

Cognitive De-Biasing and the Assessment Of Pediatric Bipolar Disorder

Decades of research have demonstrated that relying solely on clinical judgment leaves one prone to a host of cognitive errors that compromise optimal decision-making. Clinical judgment appears to be particularly vulnerable to faulty heuristics and biases when assessing for pediatric bipolar disorder, as evidenced by staggering rates of misdiagnosis and overdiagnosis. Despite abundant evidence documenting the problems associated with clinical judgment, little research to date has explored the effectiveness of targeted interventions, or cognitive de-biasing strategies, for improving clinical judgment in mental health practice. The present project developed an intervention aimed at reducing cognitive-based error in the assessment of pediatric bipolar disorder. The study design was a randomized controlled trial and participants were mental health professionals (N = 79) with experience treating pediatric populations. The treatment and control groups responded to similar case vignettes and primary outcome measures were clinicians' diagnoses and treatment decisions. Unlike participants in the control group, participants in the treatment group received the cognitive de-biasing intervention and evidenced greater overall judgment accuracy, p<.0005. Participants in the treatment group also committed significantly fewer decision-making errors, p<.0005. Study findings can significantly advance the mental health field as improving clinical judgment, especially in cases of complicated diagnoses such as pediatric bipolar, are scientific and clinical priorities.Doctor of Philosoph

An operational overview of the EXport Processes in the Ocean from RemoTe Sensing (EXPORTS) Northeast Pacific field deployment

The goal of the EXport Processes in the Ocean from RemoTe Sensing (EXPORTS) field campaign is to develop a predictive understanding of the export, fate, and carbon cycle impacts of global ocean net primary production. To accomplish this goal, observations of export flux pathways, plankton community composition, food web processes, and optical, physical, and biogeochemical (BGC) properties are needed over a range of ecosystem states. Here we introduce the first EXPORTS field deployment to Ocean Station Papa in the Northeast Pacific Ocean during summer of 2018, providing context for other papers in this special collection. The experiment was conducted with two ships: a Process Ship, focused on ecological rates, BGC fluxes, temporal changes in food web, and BGC and optical properties, that followed an instrumented Lagrangian float; and a Survey Ship that sampled BGC and optical properties in spatial patterns around the Process Ship. An array of autonomous underwater assets provided measurements over a range of spatial and temporal scales, and partnering programs and remote sensing observations provided additional observational context. The oceanographic setting was typical of late-summer conditions at Ocean Station Papa: a shallow mixed layer, strong vertical and weak horizontal gradients in hydrographic properties, sluggish sub-inertial currents, elevated macronutrient concentrations and low phytoplankton abundances. Although nutrient concentrations were consistent with previous observations, mixed layer chlorophyll was lower than typically observed, resulting in a deeper euphotic zone. Analyses of surface layer temperature and salinity found three distinct surface water types, allowing for diagnosis of whether observed changes were spatial or temporal. The 2018 EXPORTS field deployment is among the most comprehensive biological pump studies ever conducted. A second deployment to the North Atlantic Ocean occurred in spring 2021, which will be followed by focused work on data synthesis and modeling using the entire EXPORTS data set

Too Much of a Good Thing? Overexertion of Self-Control and Dietary Adherence in Individuals with Type 2 Diabetes

Objectives The resource model of self‐control posits that self‐control is a finite resource that can be depleted. Individuals with diabetes must continually restrict their diet, requiring self‐control. As a result, dietary adherence is difficult, and lapses are common. People with diabetes who overexert self‐control following a lapse may be especially likely to experience a subsequent relapse, as suggested by the resource model. This investigation used the resource model of self‐control to test whether overexertion of dietary self‐control following a lapse would be predictive of a subsequent relapse in dietary control. Design We tested this prediction in a daily diary study of 128 individuals with diabetes (Mage = 66.12). Methods Participants\u27 reports of their daily dietary adherence were used to define lapses in adherence, post‐lapse adherence, and relapses. Results Individuals who overexerted self‐control after a lapse were more likely to experience a subsequent relapse (OR = 3.276, p = .016) and to do so sooner (HR = 2.12, p = .023). Conclusions People with diabetes may seek to compensate for a lapse in adherence by overexerting self‐control, but doing so may deplete their self‐control and increase the risk of a future relapse

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups, 3 parent focus groups, and 10 youth semi-structured interviews. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate support and lack of family involvement; however, parents and therapists, in particular, identified different contributing factors to these barriers. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research

Clinician and Parent Perspectives on Parent and Family Contextual Factors that Impact Community Mental Health Services for Children with Behavior Problems

The present study employed qualitative methods to examine multiple stakeholder perspectives regarding the role of parent and family contextual factors on community child mental health treatment for children with behavior problems. Findings suggest agreement between clinicians and parents on the number, types and importance of parent and family factors in children’s mental health services; however, stakeholders differed in reports of which factors were most salient. Specifically, clinicians endorsed most factors as being equally salient, while parents described a few salient factors, with parental stress and inadequate social support being the most frequently discussed. These qualitative data further elucidate the context of community services and have implications for evidence-based practice implementation and improving community care