Challenges and Opportunities in Behavioral Psychology
Schauss, E., Allen, S., Li, C., Hawes, K., Neal, M., Loveless, C., McHugh, N., Zettler, H., Burgess, M., Rashed, J., & Ahern, B. (2023)
The COVID-19 pandemic of 2020 has led to increased awareness of mental health needs among pediatric populations. As the number of pediatric mental health emergency department visits have increased, so has the need for integrated behavioral health services in hospitals. This paper describes a standard of mental health care and the benefits of providing mental health services in pediatric hospital settings. The Trauma Mental Health Counseling Program, Hurt-2- Healing (H2H™) was developed and implemented in a Level-1 pediatric hospital and has served a total of 1,523 pediatric trauma patients and their caregivers since 2021. This program established a new hospital-based standard of mental healthcare for pediatric trauma patients and their caregivers. A questionnaire was developed to evaluate the efficacy of the Hurt-2-Healing program within domains such as openness to seeking counseling, psychoeducation, helpfulness of counseling, and ability to cope with the traumatic injury. The majority of (83%) patients/caregivers had no previous counseling experience prior to hospital admittance. Questionnaire responses indicated that after receiving mental health services, caregivers felt more aware of their children’s mental health needs and reported being more open to seeking future mental health counseling services for their child. Further, most respondents were in strong agreement that receiving mental health counseling services during the hospital stay was helpful. These results highlight the need for, and benefit of, providing a standard of care integrating behavioral health services in pediatric hospitals.
Blum, K., Gold, M. S., Cadet, J. L., Lewis, M., McLaughlin, T. J., Braverman, E. R., Elman, I., Carney, B., Cortese, R., Abijo, T., Bagchi, D., Giordano, J., Dennen, C. A., Baron, D., Thanos, P. K., Soni, D., Makale, M., Makale, M., Murphy, K. L., . . . Badgaiyan, R. D. (2023)
Addiction, albeit some disbelievers like Mark Lewis , is a chronic, relapsing brain disease, resulting in unwanted loss of control over both substance and non- substance behavioral addictions leading to serious adverse consequences . Addiction scientists and clinicians face an incredible challenge in combatting the current opioid and alcohol use disorder (AUD) pandemic throughout the world. Provisional data from the Centers for Disease Control and Prevention (CDC) shows that from July 2021-2022, over 100,000 individuals living in the United States (US) died from a drug overdose, and 77,237 of those deaths were related to opioid use . This number is expected to rise, and according to the US Surgeon General it is highly conceivable that by 2025 approximately 165,000 Americans will die from an opioid overdose. Alcohol abuse, according to data from the World Health Organization (WHO), results in 3 million deaths worldwide every year, which represents 5.3% of all deaths globally .
Mahrer, N. E., Sommer, V., Берман, Д. И., N, N., & Gold, J. I. (2023)
Youth with chronic medical conditions need accessible and effective mental health interventions to address high levels of disruption in their psychological, social, and emotional development. Acceptance and Commitment Therapy (ACT) is an empirically supported psychotherapy based on behavioral interventions that combines the principles of Relational Frame Theory and Mindfulness. ACT has been shown to be effective in populations of youth with various chronic conditions. As telehealth use has increased, ACT has been administered virtually on an individual level to adults and adolescents with chronic conditions, including chronic pain and Type II diabetes. However, few studies have incorporated a group-based element to the virtual delivery of ACT, which may be more accessible, cost-effective and may have additional therapeutic value in the form of peer connection and cohesion. To investigate the potential benefits of a virtual group model, we developed a web-based virtual ACT (vACT) group intervention for youth with chronic illness aged 14-21. The 6-week virtual group consisted of 1.5-hour sessions that each focused on a unique ACT concept: acceptance, values, mindfulness, cognitive defusion, experiential avoidance, and willingness/commitment. Additionally, the sessions included exercises to engage group members and teach skills. Baseline, post-, and follow-up data were collected on stress, mental health, functional outcomes, and satisfaction from one participant, “Kasey”, a 14-year-old Latina adolescent with comorbid Type I diabetes, depression, and anxiety. This case report details the procedures for the vACT group, discusses the barriers, and provides examples and recommendations for future administration of the group model. The report also describes Kasey’s experience during the group and presents quantitative/qualitative data supporting her improvement. Kasey’s perceived stress declined across sessions, while her anxiety sensitivity and depressive symptoms improved from the moderate range to the mild range, with sustained improvements at follow-up. Additionally, Kasey reported improvements in her peer relations with sustained improvements at follow-up, which was initially a significant concern. This case report provides promising preliminary data for the virtual administration of a group-based ACT intervention. We hope that clinicians can use this approach to provide evidence-based services that can reach a wider range of youth with chronic illnesses who may not otherwise have access to care and/or are estranged from their peers.
Mujica, A. O., Crowell, C. R., Villano, M., & Uddin, K. (2022)
Social media addiction is a growing problem throughout the world. It has been characterized as a type of behavioral addiction, which can be measured using standardized criteria based on six general properties of addiction criteria: salience, mood modification, tolerance, withdrawal symptoms, conflict and relapse. Several studies have found a prevalence of approximately 10% for social media addiction in individuals across the globe, indicating that this problem is common and widespread. Deleterious effects of this disorder include depressive symptoms, increased anxiety, and a lowered sense of personal well-being. Social media addiction also has been linked to neuroplastic changes that diminish attention and impede an individual’s ability to focus.
There many dimensions of social media that can foster addiction, including the exploitation of evolutionarily old urges to communicate and socialize, as well as intentional design of the user interface to hook users into constant use. There is little doubt that social media companies are financially incentivized to maximize user attentiveness to ads (i.e., ad views and clicks) on their platforms because user attention is the product for which they are paid. These companies maximize user attentiveness in two primary ways: first, by intentionally designing the interface to have properties intended to hold users’ attention; and second, by personalizing the content shown to users in order to make it more interesting and engaging for them. Social media addiction likely arises from the vicious cycle involving user attention leading to powerful dopamine-related reinforcement, which then stimulates more attention intended to achieve more reinforcement.
This paper provides an overview of this multifaceted problem of social media addiction, including a brief review of addictions in general, social media addiction in particular, and a discussion of the prevalence and consequences of this addiction. Also discussed is the role social media companies play in addiction by design, along with the critical need to present solutions to social media addiction. These solutions, beginning with redesign of the user interface properties to make them more humane and ethical, are possible, but will not be easy. However, we all must work toward a world in which people use technology for their own well-being rather than for the well-being of those who control the technology.
Ricke, E., & Dijkstra, A. (2023)
Introduction: Pulmonary rehabilitation is considered an important method of improving health-related quality of life in patients with chronic obstructive pulmonary disease. A critical component to the success of pulmonary rehabilitation is exercise adherence, which is often lower than 50%. When there is a better understanding on the psychological determinants of adherence, theory-informed interventions can be developed to improve adherence. Therefore, the aim of this study was to examine the utility of the Theory of Planned Behavior in combination with the therapeutic alliance in explaining exercise adherence in a prospective cohort study of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease to ultimately increase adherence with psychological interventions. In addition, we examined the influence of the Theory of Planned Behavior determinants and alliance in combination with clinical determinants on adherence.
Methods: At baseline, 196 patients from 53 physiotherapy practices in the Netherlands and Belgium completed measures of the Theory of Planned Behavior, and disease and demographic characteristics. After three months they completed measures of alliance. Their physiotherapist provided exercise adherence measures after 12 months. Data were analyzed using Spearman’s correlations, hierarchical linear multiple regression analyses and mediation analysis.
Results: Hierarchical linear multiple regression analyses indicated that intention (b = 0.72; p < 0.001) and alliance (b = 0.26; p < 0.001) explained 24.8% of the variance in exercise adherence. After adding Medical Research Council dyspnea score and depression to the model, 35.6% of the variance could be explained. Perceived behavioral control, attitude, and alliance, explained 37.9% of variance in exercise intention. The effect of alliance on adherence was partially mediated by intention.
Conclusion: Extending the Theory of Planned Behavior with the concept of alliance is a promising innovation to understand exercise adherence of patients who are coached by a health care professional. Healthcare providers should obtain information about their patients’ attitudes, perceived behavioral control, and alliance, to inform their coaching and further psychosocial interventions. Concrete recommendations are provided for effectively addressing these psychosocial determinants of adherence within the patient-coaching relationship.
Rajan, L., Pearce, A. L., Mackey, E. R., Nadler, E. P., & Vaidya, C. J. (2023)
Obesity is associated with altered food-related reward processing, but its impact on non-food reward remains unclear. This question is both timely due to rising rates of severe obesity and important because adolescence is a period of heightened reward seeking behavior. We used computational modeling and functional magnetic resonance imaging to examine monetary reward processing using classic experimental tasks in 35 adolescents (14-18 years-old, 13 male) with severe obesity (n=18) and without obesity (n=17). Participants completed the Balloon Analog Risk Taking Task to assess reward-related decision-making and the Monetary Incentive Delay task to assess neural correlates of reward anticipation. Reward-related decision-making model parameters revealed no differences in reward sensitivity but less adaptive decision-making (response consistency) in those with obesity compared to without obesity. Other metrics (e.g., number of balloons popped, number of pumps, and total points) did not differ between groups. During reward anticipation, those with obesity had lower activation than without obesity in ventral tegmental area and prefrontal cortex, canonical regions for reward and cognitive control, respectively. Weight status moderated associations between ventral tegmental area activation and reward-related decision-making metrics such that higher ventral tegmental area activation was associated with more risky decision-making (more popped balloons) in those with but not without obesity. Functional connectivity of ventral tegmental area with right inferior frontal gyrus and left superior temporal gyrus was greater higher in OB than nonOB. Associations between value-related ventral tegmental area-superior temporal gyrus connectivity and reward-related decision-making metrics were moderated by weight status such that higher connectivity was associated with greater number of pumps and points for without obesity and less risky decision-making for those with obesity. Therefore, differences in activation and connectivity between groups may suggest differences in decision-making strategies. Together, findings reveal that ventral tegmental area, prefrontal, and temporal engagement during monetary reward anticipation differs between adolescents with and without obesity and may contribute to individual differences in reward-related decision-making. Such domain-general alteration of reward processing may have far reaching consequences, not only for food intake but also functions central to motivational behavior such as learning and socialization during adolescence, a sensitive period in development. These findings highlight the importance of considering reward more broadly when designing and tailoring behavioral interventions in adolescent obesity.
Broderick, P. A. (2022)
Neuromolecular Imaging (NMI) for white matter detection, distinct from that of gray matter is an inventive art. (1) This imaging technique demonstrates, for the first time, a LIVE and continuous videotracking nanotechnology for distinguishing white matter from gray matter in the brain of epilepsy patients, online, in real time and for long periods of time. NMI is known to perform with unrivaled temporal and spatial operational reliability and reproducibility Thus, a nanotechnology for white matter disorders, for example, leukodystrophies, is published for the first time. The purpose of this paper is to present a critical distinction for white versus gray matter in hippocampal and neocortical resected tissue derived from mesial and neocortical temporal lobe epilepsy patients en bloc during intraoperative surgery; the patients present as medically refractory to classical pharmacotherapeutics. The tiny carbon-based lipid polymeric sensor, the BRODERICK PROBE® readily sees white matter in contrast to gray matter in brain neuroanatomic substrates as it continually senses the glia or the neuron, white or gray matter, respectively, with distinct clarity via electroactive signal processing. The difference between white and gray matter is striking as the videotrace slides smoothly from the white to the gray milieu. Thus, a primary in vivo white matter nanotechnology is presented to advance diagnosis and therapy for white and gray matter abnormalities in the brain and spinal cord.