Training, supervision, and experience of coaches offering digital guided self-help for mental health concerns

Accessible, low-cost intervention options are necessary to address the rise in mental health problems among college students. Digital guided self-help, or coached, programs have been developed to provide such services, with many commercially available. As such, there are a large and growing number of individuals coaching these programs. However, an unmet need is to evaluate and assess best practices for training and supervising individuals in these positions. To this end, we describe how we recruited, trained, and supervised coaches as part of a large randomized controlled trial using a widely available digital commercial platform. Coaches were trained to provide digital guided self-help for depression, anxiety, and/or eating disorders for college students. Coaches initially attended three live training sessions over 2-3 weeks, viewed multiple training videos, and read a detailed coaching manual developed by our team. Thereafter, they attended weekly supervision. Following their term, coaches completed an exit survey to assess their supervision and training experiences. A total of 37 of 70 (53%) graduate-level student coaches completed the survey. The experience was reported as very positive (95%). In particular, the majority reported feeling well prepared, more confident, and felt they had developed useful skills for their own practice

Compatibility issue related to the use of biodiesel with automotive materials

Biodiesel fuel can be used in diesel engine in accordance to the standard provided. However, a significant issue with biodiesel fuel was noted. Some of the fuel quality were outside the accepted range of the specification stated in the standard. Thus, this can be lead to the problem of utilization them in diesel engine. Moreover, material compatibility is the main concern whenever the fuel composition is altered in the fuel system. A large variety of metals and non-metals are worn as the material of construction for the various components of the fuel system. Introduction of biodiesel fuel often generate many problems in the components of the fuel system. This paper attempts to present the compatibility issue related to the use of biodiesel with automotive material

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression among University Students:A Secondary Analysis of a Randomized Clinical Trial

Importance: Guided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT. Objective: To develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors. Design, Setting, and Participants: This prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022. Interventions: Participants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435). Main Outcomes and Measures: Remission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline. Results: The study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P =.003) or treatment as usual (40.0% [2.7%]; P =.001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P =.007; self-guided i-CBT: 25.4% [8.8%]; P =.004; treatment as usual: 31.0% [9.4%]; P =.001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P =.14; treatment as usual: 53.0% [6.0%]; P =.25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P =.001; treatment as usual: 41.8% [3.2%]; P &lt;.001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P =.07). Conclusions and Relevance: Guided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings. Trial Registration: ClinicalTrials.gov Identifier: NCT04780542.</p

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

A Randomized Controlled Trial of a 14-Day Mindfulness Ecological Momentary Intervention (MEMI) for Generalized Anxiety Disorder

BACKGROUND: Little is known about whether brief mindfulness ecological momentary interventions (MEMI) yield clinically beneficial effects. This gap exists despite the rapid growth of smartphone mindfulness applications. Specifically, no prior brief MEMI has targeted generalized anxiety disorder (GAD). Moreover, although theories propose that MEMI can boost executive functioning (EF), they have largely gone untested. Thus, this randomized controlled trial (RCT) aimed to address these gaps by assessing the efficacy of a 14-day smartphone MEMI (vs. self-monitoring placebo (SMP)). METHOD: Participants with GAD were randomly assigned to either condition (68 MEMI, 42 SMP). MEMI participants exercised multiple core mindfulness strategies and were instructed to practice mindfulness continually. Comparatively, SMP participants were prompted to practice self-monitoring and were not taught any mindfulness strategies. All prompts occurred five times a day for 14 consecutive days. Participants completed self-reports and neuropsychological assessments at baseline, post-treatment, and 1-month follow-up (1MFU). Piecewise hierarchical linear modeling analyses were conducted. RESULTS: MEMI (vs. SMP) produced greater pre-1MFU reductions in GAD severity and perseverative cognitions (between-group |d|=0.393–0.394) and stronger improvements in trait mindfulness and performance-based inhibition (|d|=0.280–0.303). Further, MEMI (vs. SMP) led to more considerable pre-post-treatment reductions in state-level depression and anxiety and more mindfulness gains (|d|=0.50–1.13). Overall, between-treatment effects were stronger at pre-1MFU than pre-post-treatment for trait-level than state-level treatment outcome measures. CONCLUSIONS: Preliminary findings suggest that the beneficial effect of an unguided brief MEMI to target pathological worry, trait mindfulness, and EF is modest yet potentially meaningful. Other theoretical and clinical implications were discussed

Examining the Effects of a Brief, Fully Self-Guided Mindfulness Ecological Momentary Intervention on Empathy and Theory-of-Mind for Generalized Anxiety Disorder: Randomized Controlled Trial

BackgroundThe utility of brief mindfulness ecological momentary interventions (EMIs) to improve empathy and theory-of-mind has been underinvestigated, particularly in generalized anxiety disorder (GAD). ObjectiveIn this randomized controlled trial, we aimed to examine the efficacy of a 14-day, fully self-guided, mindfulness EMI on the empathy and theory-of-mind domains for GAD. MethodsAdults (aged ≥18 y) diagnosed with GAD were randomized to a mindfulness EMI (68/110, 61.8%) or self-monitoring app (42/110, 38.2%) arm. They completed the Interpersonal Reactivity Index self-report empathy measure and theory-of-mind test (Bell-Lysaker Emotion Recognition Task) at prerandomization, postintervention, and 1-month follow-up (1MFU) time points. Hierarchical linear modeling was conducted with the intent-to-treat principle to determine prerandomization to postintervention (pre-post intervention) and prerandomization to 1MFU (pre-1MFU) changes, comparing the mindfulness EMI to self-monitoring. ResultsObserved effects were generally stronger from pre-1MFU than from pre-post intervention time points. From pre-post intervention time points, the mindfulness EMI was more efficacious than the self-monitoring app on fantasy (the ability to imagine being in others’ shoes; between-intervention effect size: Cohen d=0.26, P=.007; within-intervention effect size: Cohen d=0.22, P=.02 for the mindfulness EMI and Cohen d=−0.16, P=.10 for the self-monitoring app). From pre-1MFU time points, the mindfulness EMI, but not the self-monitoring app, improved theory-of-mind (a window into others’ thoughts and intentions through abstract, propositional knowledge about their mental states, encompassing the ability to decipher social cues) and the fantasy, personal distress (stress when witnessing others’ negative experiences), and perspective-taking (understanding others’ perspective) empathy domains. The effect sizes were small to moderate (Cohen d=0.15-0.36; P.99) from pre-1MFU time points. No between-intervention and within-intervention effects on empathic concern (feeling affection, compassion, and care when observing others in distress, primarily attending to their emotional well-being) were observed from pre-post intervention and pre-1MFU time points. ConclusionsThe brief mindfulness EMI improved specific domains of empathy (eg, fantasy, personal distress, and perspective-taking) and theory-of-mind with small to moderate effect sizes in persons with GAD. Higher-intensity, self-guided or coach-facilitated, multicomponent mindfulness EMIs targeting the optimization of social relationships are likely necessary to improve the empathic concern domain in this population. Trial RegistrationClinicalTrials.gov NCT04846777; https://clinicaltrials.gov/study/NCT0484677

A Cross-Lagged Prospective Network Analysis of Depression and Anxiety and Cognitive Functioning Components in Midlife Community Adult Women

Background: The scar theory proposes that heightened depression and anxiety precede and predict worse cognitive functioning outcomes, whereas the vulnerability model posits the opposite pathway. However, most investigations on this topic have been cross-sectional, which precludes causal inferences. Thus, our study used both contemporaneous and temporal cross-lagged panel network analysis to facilitate causal inferences in understanding the relations between psychopathology components and cognitive functioning. Methods: Racially-diverse midlife women (n = 3,302) participated in the Study of Women's Health Across the Nation across two time-points, spanning one year apart. Five psychopathology (anxiety symptoms, depressed mood, somatic symptoms, positive affect, interpersonal problems) and cognitive functioning nodes (working memory (WM), processing speed (PS), visual memory (VSM), auditory memory (ARM)) were assessed. Results: Contemporaneous networks yielded notable inverse between-node relations (edges) for interpersonal problems and reduced VSM and PS, and between depressed mood or anxiety symptoms and VSM, ARM, or PS. Moreover, nodes that had the highest likelihood to bridge psychopathology and cognitive functioning constructs were positive affect, anxiety symptoms, WM, and ARM. Temporal networks produced edges inconsistent with the vulnerability theory. Higher depressed mood and somatic symptoms and lower positive affect were related to reduced future PS, WM, and/or VSM. Likewise, greater interpersonal issues and anxiety symptoms were linked to poorer future ARM and WM. Also, positive affect had the strongest effect on future nodes. Conclusions: These results provide stronger support for the scar theory than the vulnerability theory

Mindfulness Enhances Cognitive Functioning: A Meta-Analysis of 95 Randomized Controlled Trials

Background: The past 30 years have witnessed growing scientific interest regarding the impact of mindfulness-based interventions (MBIs) on cognitive functions. Several theories propose that habitually exercising mindfulness skills can improve cognitive abilities, but no comprehensive quantitative reviews of the effect of MBIs on global and unique cognitive domains exist to date. Method: This systematic review thus examined the effects of MBI on global cognitive ability (GCA) and 16 specific cognitive domains. MBI randomized controlled trials (RCTs) that administered cognitive tests pre- and post-treatment were included. Open-trials, non-randomized MBIs, and case-control studies were excluded. Keywords included “mindful*,” AND “executive attention (EA),” OR “working memory (WM).” Robust variance estimation and moderator analyses were conducted. Results: Ninety-five RCTs (n = 7,408) met eligibility criteria. MBI (vs. waitlist or no-treatment) had small-to-moderate significant effects on GCA, WM accuracy, inhibition accuracy and latency, EA, sustained attention accuracy, processing speed, and subjective attentional control (SAC) (g = 0.24 – 0.52). Likewise, MBI (vs. active control) had small-to-moderate positive effects on GCA, orienting, EA, WM accuracy, sustained attention (indexed by intra-individual coefficient of variation), and SAC (average g = 0.17 – 0.41). Age, gender, study quality, treatment duration, publication year, retention, statistical analysis, and country, moderated some treatment effects. Publication bias analyses showed that reliable treatment effects were restricted to EA, WM accuracy, inhibition accuracy, sustained attention, and SAC, depending on the control group. Conclusion: MBIs confer notable neuropsychological benefits and dose-response effects on some specific (vs. global) cognitive domains. Limitations, theoretical, and applied implications are discussed. (Note: This paper has not been peer reviewed. Please do not copy or cite without author's permission.