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"Behavioural"
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Inside the nudge unit : how small changes can make a big difference
Adding a crucial line to a tax reminder brought forward millions in extra revenue; prompting people to become organ donors while paying for their car tax added an extra 100,000 donors to the register in a single year. Halpern heads up the UK government's \"Nudge Unit,\" the world's first government institution that uses behavioral economics to examine and influence human behavior, to \"nudge\" us into making better decisions. Here he shows you how to make better choices and improve your life.
A randomized trial of online single-session interventions for adolescent depression during COVID-19
2022
The COVID-19 pandemic has potentially increased the risk for adolescent depression. Even pre-pandemic, <50% of youth with depression accessed care, highlighting needs for accessible interventions. Accordingly, this randomized controlled trial (ClinicalTrials.gov: NCT04634903) tested online single-session interventions (SSIs) during COVID-19 in adolescents with elevated depression symptoms (N = 2,452, ages 13–16). Adolescents from all 50 US states, recruited via social media, were randomized to one of three SSIs: a behavioural activation SSI, an SSI teaching that traits are malleable and a supportive control. We tested each SSI’s effects on post-intervention outcomes (hopelessness and agency) and three-month outcomes (depression, hopelessness, agency, generalized anxiety, COVID-19-related trauma and restrictive eating). Compared with the control, both active SSIs reduced three-month depressive symptoms (Cohen’s d = 0.18), decreased post-intervention and three-month hopelessness (d = 0.16–0.28), increased post-intervention agency (d = 0.15–0.31) and reduced three-month restrictive eating (d = 0.12–17). Several differences between active SSIs emerged. These results confirm the utility of free-of-charge, online SSIs for high-symptom adolescents, even in the high-stress COVID-19 context.In a randomized controlled trial, Schleider et al. show that single-session online interventions are able to reduce depression symptoms up to three months later in adolescents.
Journal Article
‘What Does the Anemonefish Say?’: Investigating Amphiprion percula 's Acoustic Behaviour
2025
Acoustic communication plays a critical role in mediating social interactions, coordinating behaviours and maintaining group cohesion in many animals. While fish are known to produce a diverse range of sounds, most studies have been conducted in laboratory settings, limiting our understanding of how vocalisations function in natural social and ecological contexts. In this study, we provide a comprehensive examination of vocal behaviour in social groups of orange anemonefish ( Amphiprion percula ), an anemonefish species with strict size‐based hierarchies. Using underwater video and acoustic recordings from nine wild groups in Kimbe Bay, Papua New Guinea, we quantified acoustic features of individual vocalisations and linked them to behavioural contexts. We also examined the effect of body size and social status on vocalisation's acoustic features. Our findings demonstrate that A. percula 's vocalisations differ between behavioural contexts, highlighting the role of acoustic signals in signalling submission, regulating conflict, and maintaining group hierarchy. Behavioural context emerged as the strongest predictor of vocal variation, with body size and social rank providing additional variation. This study underscores the importance of field‐based investigations to capture the ecological and social complexity of acoustic communication. These findings establish a baseline for future functional studies, including playback experiments, and provide critical insight into the adaptive significance of sound in social fish communities.
Journal Article
Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial
2017
People with social anxiety disorder (SAD) fear social interactions and may be reluctant to seek treatments involving exposure to social situations. Social exposure conducted in virtual reality (VR), embedded in individual cognitive-behavioural therapy (CBT), could be an answer.
To show that conducting VR exposure in CBT for SAD is effective and is more practical for therapists than conducting exposure
Participants were randomly assigned to either VR exposure (
= 17),
exposure (
= 22) or waiting list (
= 20). Participants in the active arms received individual CBT for 14 weekly sessions and outcome was assessed with questionnaires and a behaviour avoidance test. (Trial registration number ISRCTN99747069)
Improvements were found on the primary (Liebowitz Social Anxiety Scale) and all five secondary outcome measures in both CBT groups compared with the waiting list. Conducting exposure in VR was more effective at post-treatment than
on the primary outcome measure and on one secondary measure. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists than
exposure.
Using VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure.
Journal Article
Psychotherapies for eating disorders: findings from a rapid review
2023
Background
Psychotherapy is considered central to the effective treatment of eating disorders—focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development.
Methods
The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021–2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper.
Results
281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence.
Conclusions
Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.
Plain English Summary
Evaluating the efficacy of treatment options for eating disorders (EDs) is important and necessary to inform both treatment guidelines and clinical practice. However, treatment outcomes in studies, and in clinical practice, can vary widely. Therefore, this review aimed to pool evidence related to a wide range of psychological treatments to help better understand what gaps in treatment need to be addressed. Using a rapid review method, three academic databases were searched, and 281 articles were identified and analysed. Results indicated that cognitive-behavioural approaches had the most evidence for well-defined EDs (such as anorexia nervosa, bulimia nervosa, and binge eating disorder). However, little research was found on other types of EDs. There was emerging evidence that provided support for self-help, group, and computer/internet-based therapies. Overall, the findings highlighted that more research is required on novel eating disorder treatments beyond what is currently available and being used as ‘gold standard’.
Journal Article
Behavioral Economics and Public Policy: A Pragmatic Perspective
2015
The debate about behavioral economics–the incorporation of insights from psychology into economics–is often framed as a question about the foundational assumptions of economic models. This paper presents a more pragmatic perspective on behavioral economics that focuses on its value for improving empirical predictions and policy decisions. I discuss three ways in which behavioral economics can contribute to public policy: by offering new policy tools, improving predictions about the effects of existing policies, and generating new welfare implications. I illustrate these contributions using applications to retirement savings, labor supply, and neighborhood choice. Behavioral models provide new tools to change behaviors such as savings rates and new counterfactuals to estimate the effects of policies such as income taxation. Behavioral models also provide new prescriptions for optimal policy that can be characterized in a non-paternalistic manner using methods analogous to those in neoclassical models. Model uncertainty does not justify using the neoclassical model; instead, it can provide a new rationale for using behavioral nudges. I conclude that incorporating behavioral features to the extent they help answer core economic questions may be more productive than viewing behavioral economics as a separate subfield that challenges the assumptions of neoclassical models.
Journal Article
The effects of once- versus twice-weekly sessions on psychotherapy outcomes in depressed patients
by
Hollon, Steven D.
,
van den Boogaard, Michael
,
Huibers, Marcus J. H.
in
Adult
,
Adults
,
Attrition
2020
It is unclear what session frequency is most effective in cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) for depression.
Compare the effects of once weekly and twice weekly sessions of CBT and IPT for depression.
We conducted a multicentre randomised trial from November 2014 through December 2017. We recruited 200 adults with depression across nine specialised mental health centres in the Netherlands. This study used a 2 × 2 factorial design, randomising patients to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II at baseline, before session 1, and 2 weeks, 1, 2, 3, 4, 5 and 6 months after start of the intervention. Intention-to-treat analyses were conducted.
Compared with patients who received weekly sessions, patients who received twice weekly sessions showed a statistically significant decrease in depressive symptoms (estimated mean difference between weekly and twice weekly sessions at month 6: 3.85 points, difference in effect size d = 0.55), lower attrition rates (n = 16 compared with n = 32) and an increased rate of response (hazard ratio 1.48, 95% CI 1.00-2.18).
In clinical practice settings, delivery of twice weekly sessions of CBT and IPT for depression is a way to improve depression treatment outcomes.
Journal Article
Feasibility and acceptability of two incentive-based implementation strategies for mental health therapists implementing cognitive-behavioral therapy: a pilot study to inform a randomized controlled trial
by
Beidas, Rinad S.
,
Williams, Nathaniel J.
,
Adams, Danielle R.
in
Adolescent
,
Adult
,
Behavior modification
2017
Background
Informed by our prior work indicating that therapists do not feel recognized or rewarded for implementation of evidence-based practices, we tested the feasibility and acceptability of two incentive-based implementation strategies that seek to improve therapist adherence to cognitive-behavioral therapy for youth, an evidence-based practice.
Methods
This study was conducted over 6 weeks in two community mental health agencies with therapists (
n
= 11) and leaders (
n
= 4). Therapists were randomized to receive either a financial or social incentive if they achieved a predetermined criterion on adherence to cognitive-behavioral therapy. In the first intervention period (block 1; 2 weeks), therapists received the reward they were initially randomized to if they achieved criterion. In the second intervention period (block 2; 2 weeks), therapists received both rewards if they achieved criterion. Therapists recorded 41 sessions across 15 unique clients over the project period. Primary outcomes included feasibility and acceptability. Feasibility was assessed quantitatively. Fifteen semi-structured interviews were conducted with therapists and leaders to assess acceptability. Difference in therapist adherence by condition was examined as an exploratory outcome. Adherence ratings were ascertained using an established and validated observational coding system of cognitive-behavioral therapy.
Results
Both implementation strategies were feasible and acceptable—however, modifications to study design for the larger trial will be necessary based on participant feedback. With respect to our exploratory analysis, we found a trend suggesting the financial reward may have had a more robust effect on therapist adherence than the social reward.
Conclusions
Incentive-based implementation strategies can be feasibly administered in community mental health agencies with good acceptability, although iterative pilot work is essential. Larger, fully powered trials are needed to compare the effectiveness of implementation strategies to incentivize and enhance therapists’ adherence to evidence-based practices such as cognitive-behavioral therapy.
Journal Article
Dismantling the relative effectiveness of core components of cognitive behavioural therapy in preventing depression in adolescents: protocol of a cluster randomized microtrial
by
Bodden, Denise H. M.
,
Smit, Filip
,
Engels, Rutger C. M. E.
in
Adolescent
,
Adolescents
,
Behavioral medicine
2019
Background
Both depressive disorder and subclinical depressive symptoms during adolescence are a major public health concern. Therefore, it is important that depression is detected at an early stage and is treated preventively. Prevention based on the principles of Cognitive Behavioural Therapy (CBT) has proven to be the most effective, however research has mainly focused on the effectiveness of “prevention packages” consisting of multiple CBT-components, rather than on the distinct CBT-components. This study will evaluate the relative effectiveness of four core components of CBT (cognitive restructuring (CR), behavioural activation (BA), problem solving (PS) and relaxation (RE)). In addition the relative (cost-)effectiveness of four different sequences of these components will be evaluated: (1) CR – BA – RE – PS, (2) BA – CR – RE – PS, (3) PS – GA – CR – RE and (4) RE – PS – BA – CR.
Methods
We will perform a non-blinded multisite cluster randomized prevention microtrial with four parallel conditions consisting of the four sequences. The four sequences of components will be offered in groups of high school students with elevated depressive symptoms. For each CBT-component a module of three sessions is developed. Assessments will be conducted at baseline, after each CBT-component, prior to each session, at post-intervention and at 6-month follow-up. Potential moderators and mediators will be evaluated exploratively to shed light on for whom the (sequences of) CBT-components are most effective and how effects are mediated.
Discussion
The potential value of the study is insight in the relative effectiveness of the four most commonly used CBT-components and four different sequences, and possible moderators and mediators in the prevention of depression among adolescents. This knowledge can be used to optimize and personalize CBT-programs.
Trial registration
The study is registered in the Dutch Trial Register (Trial
NL5584
/ NTR6176) on October 13, 2016.
Journal Article