A game-based learning approach to sleep hygiene education: a pilot investigation.

Introduction: Sleep hygiene education (SHE) consists of environmental and behavioral practices primarily intended to reduce sleep problems. Currently considered ineffective as a stand-alone treatment, the manner in which the education is typically delivered may be ineffective for the acquisition of new knowledge. The purpose of this study was to determine if a more engaging teaching medium may improve the efficacy of sleep hygiene education. This study examined the use of game-based learning to teach SHE to individuals with sleep problems. Methods: 35 participants played the SHE games for 30 days. Differences in pre- and post-state anxiety and sleep quality measures were examined. Results: Participants had significant improvements in sleep quality and state anxiety after using the app for 30 days, although scores for the majority of patients remained elevated. Discussion: This pilot investigation provides initial evidence for the efficacy of a game-based approach to SHE.

Workplace coaching: a meta-analysis and recommendations for advancing the science of coaching.

Workplace coaching has experienced a dramatic rise in popularity over the past decade and is one of the fastest growing performance-enhancing interventions used by modern organizations. Yet, despite its popularity, workplace coaching has not been the subject of much empirical research and a true science of coaching has yet to be developed. The purpose of this research was to update prior meta-analyzes that investigated the impact of coaching on organizational outcomes and to provide recommendations for how the field needs to evolve. Results indicated that, consistent with prior meta-analyzes, workplace coaching is effective in achieving positive organizational outcomes. The effects of several moderators were also investigated. Finally, we discuss the results in terms of recommendations for future directions that we believe will establish and advance the science of coaching.

An evaluation of completed and averted school shootings.

Introduction: For over two decades school shootings have become a significant concern, especially in the United States. Following a rampage school shooting, extensive resources are devoted to gathering all of the information surrounding the event. To date, few studies have compared completed to averted, or near-miss, school shootings. This study utilized the largest known sample of cases based in the United States in an effort to identify potential targets for prevention. Method: Data were derived from the Averted School Violence database of incidents occurring between 1999 and 2020. Statistical analyses were conducted to determine how age, co-conspirator involvement, engagement in leakage warning behavior, and motives - in isolation and in combination - varied between groups. Results: In insolation, age, co-conspirator involvement, engagement in leakage warning behaviors, and motives were significantly different between groups. However, when these variables were combined into a logistic regression, co-conspirator involvement, engagement in leakage warning behaviors, and motives involving suicidal intent emerged as statistically significant predictors of group membership. Age no longer differentiated the two types of events. Conclusion: This study demonstrates that regardless of suspect age, threats of school violence must be taken seriously and investigated fully. Further, students reporting their peers' engagement in shooting-related behaviors (e.g., bringing a gun to school, mapping school, etc.) was one of the most significant predictors that a plot will be thwarted. While perpetrators who planned with others had increased odds of their plot being identified, those acting alone still demonstrated leakage behaviors. If individuals in the school environment are educated regarding warning behaviors, lone perpetrators can still be identified and reported to authorities. The perpetrator's emotional distress, in particular depressive or suicidal thoughts were also a significant predictor of a completed school shooting. Future research efforts should focus on the development and evaluation of peer training programs to assist in the detection of school shooting warning behaviors.

A re-evaluation of Stuart's police officer stigma scale: Measuring mental health stigma in first responders.

Stigma about mental illness is often identified as one of the most prominent obstacles to seeking mental health services. This seems to be particularly true among first responders. Unfortunately, the research regarding stigma in first responders is lacking. This may be due, in part, to the absence of appropriate measurement tools to allow such research. Police Officer Stigma Scale (POSS) has recently been developed to address this issue, but its psychometric properties have gone largely untested. Therefore, this study sought to identify the underlying factor structure and internal consistency of the POSS. This paper used a sample of 135 first responders. Using factor analysis with an orthogonal rotation on Stuart's 11-item POSS, the participant's results revealed two main components, accounting for a total of 72.79% of the overall variance. Factor one is "maltreatment of colleagues with a mental disorder," and is associated with six of the 11 items on the scale, such as "Most police officers believe that a colleague who has had a mental illness is not trustworthy." Factor two is "fear of disclosing a mental disorder." It includes items such as "Most police officers would not disclose to a supervisor/manager if they were experiencing a mental illness." Findings from this research are similar to the results of previous studies with components such as unwillingness to disclose a mental health condition, fear of how the public will treat an individual with a mental disorder, and anger toward those who decide to seek treatment or get diagnosed with a mental illness. These findings imply that Stuart's POSS is reliable but needs to include two components rather than one. With the two main components, further research can now be conducted to understand why and ultimately mitigate maltreatment or stigma against first responders with a mental health condition.

After the fall: Responding to the Champlain Towers building collapse.

In June 2021, a condominium in Florida collapsed, with the loss of 98 lives. Search and rescue teams spent 2 weeks, recovering the victims. This study's objective was to assess the presence of psychological symptoms that might emerge in the following months, using the PTSD Checklist for DSM-5 (PCL-5), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder - 7 (GAD-7), Suicide Cognitions Scale-Short (SCS-S), and the Insomnia Severity Index (ISI). A monthly survey conducted for 3 months found that overall, mean scores on these measures did not indicate significant emotional distress. We then compared the scores when the group was divided into responders who recovered human remains and those who did not. Scores were significantly higher among the subgroup that recovered human remains. Fifty-three percent (53%) of this sub-group met the cut-off score for a provisional diagnosis of PTSD, depressive disorder or generalized anxiety disorder-15% met the cut-off score criteria on the PCL-5 for probable PTSD, 36.8% for probable depressive disorder on the PHQ-9, and 26.3% for probable generalized anxiety disorder on the GAD-7. The results are consistent with other investigations examining mental health after mass disasters. Specifically, not all first responders will develop emotional distress but certain recovery activities may put some responders at higher risk, with a percentage displaying psychological distress. The results emphasize the need to assess the impact of these events on the mental health of first responders and to consider strategies to prevent or mitigate the development of impairing psychopathology.

Here for My Peer: The Future of First Responder Mental Health.

Workplace interventions that leverage social tactics to improve health and well-being are becoming more common. As an example, peer mental health support interventions aim to reduce stigma and promote treatment seeking in first responder populations. Given the social nature of these interventions, it is important to consider how the preexisting social context influences intervention outcomes. A peer mental health support intervention was delivered among first responders, and self-efficacy and intention to have supportive peer conversations were measured pre-and post-intervention. Trust in peers was measured prior to the intervention. Results suggest a floor effect may exist for self-efficacy, in which a foundational level of trust and pre-intervention self-efficacy may be needed to maximize intervention effectiveness. As the future of work brings complex safety and health challenges, collaborative solutions that engage multiple stakeholders (employees, their peers, and their organization) will be needed. This study suggests that more frequent attention to pre-existing intervention context, particularly social context in peer-focused intervention, will enhance intervention outcomes.

Treating Childhood Social Anxiety Disorder With Virtual Environments and Serious Games: A Randomized Trial.

Disseminating efficacious psychological treatments remains a challenge for researchers and clinicians. In the case of social anxiety disorder (SAD), Social Effectiveness Therapy for Children (SET-C) has been demonstrated as an efficacious intervention, but elements of the protocol, such as peer generalization sessions, remain challenging to conduct in typical clinical settings. To address this need, we developed an artificially intelligent, web-based application, Pegasys-VR™, designed to replace peer generalization sessions and enhance homework compliance. The feasibility of Pegasys-VR™ was tested in a randomized controlled trial in comparison to SET-C. The results indicated that both programs were equally efficacious in decreasing anxiety and improving social skill in social encounters. Sixty-three percent (63%) of children treated with SET-C and 60% treated with Pegasys-VR™ did not meet diagnostic criteria for SAD at posttreatment. Pegasys-VR™ is a feasible, efficacious, and dissemination-friendly element of a comprehensive treatment program for social anxiety disorder in children.

Sleep disturbance and cognitive functioning among firefighters.

Firefighters are at risk for chronic sleep disruption due to their rotating 24-hour on and 48-hour off work schedule and hazardous work conditions. Forty-five firefighters were assessed to determine the impact of their shift schedule on sleep duration, sleep quality, processing speed, sustained attention, vigilance, and mental health. Assessments were conducted at the start and end of shift. Firefighters endorsed sleeping 5 hours 21 minutes at work, and the results suggest that even minimal sleep disruption affected cognitive functioning (e.g. processing speed, visual-motor coordination, and reaction time), increasing the likelihood of poor work performance or injury.

How Much Is Enough? Trauma Recall and the Exposure Therapy Process.

Theoretical models of posttraumatic stress disorder (PTSD) as well as exposure therapy (EXP) methodology suggest that trauma recall is crucial to altering the conditioned fear response associated with PTSD. However, it is unclear whether limited recall of the trauma event attenuates treatment outcomes. This study examined whether the extent of difficulty recalling aspects of a traumatic event affected fear activation, habituation, number of sessions, session length, and diagnostic outcomes in 166 Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans. Extent of trauma recall difficulty neither attenuated veterans' ability to achieve fear activation and habituation nor affected treatment outcomes. Findings suggest that even veterans who reported greater difficulty recalling their trauma event can engage successfully and benefit from EXP. This research is the first to examine trauma event recall in the context of the EXP process and contributes to the current body of literature that aims to address the question: "For whom do treatments work?"

Trauma Management Therapy and Prolonged Exposure Therapy for PTSD in an active duty sample: Design and methodology of a randomized clinical trial.

Posttraumatic stress disorder (PTSD) resulting from military service is a common, yet often chronic condition. Treatment outcome often is attenuated by programs that are (a) lengthy in nature and (b) constricted in their target outcomes. These limitations leave much of the emotional and behavioral impairment that accompanies PTSD unaddressed and/or unassessed. Typical PTSD treatment programs are 3-4 months in length, which is challenging for the pace of the nation's military. In this investigation, we will compare two treatments, Trauma Management Therapy (TMT) and Prolonged Exposure (PE), both redesigned to address the needs of active duty personnel (300 participants at 3 military installations). Specifically, we will compare the TMT Intensive Outpatient Program (IOP; 3 weeks) to PE's compressed (2 week) format. Both interventions will be compared to a standard course of PE (12 weeks). In addition to PTSD symptomatology, outcome measurement includes other aspects of psychopathology as well as changes in social, occupational, and familial impairment. Potential negative outcomes of massed treatment, such as increased suicidal ideation or increased alcohol use, will be assessed, as will genetic predictors of PTSD subtype and treatment outcome. This study will inform the delivery of care for military-related PTSD and particularly the use of intensive or compressed treatments for active duty personnel.

Trauma management therapy with virtual-reality augmented exposure therapy for combat-related PTSD: A randomized controlled trial.

Virtual reality exposure therapy (VRET) realistically incorporates traumatic cues into exposure therapy and holds promise in the treatment of combat-related posttraumatic stress disorder (PTSD). In a randomized controlled trial of 92 Iraq and Afghanistan veterans and active duty military personnel with combat-related PTSD, we compared the efficacy of Trauma Management Therapy (TMT; VRET plus a group treatment for anger, depression, and social isolation) to VRET plus a psychoeducation control condition. Efficacy was evaluated at mid- and post-treatment, and at 3- and 6-month follow-up. Consistent with our hypothesis, VRET resulted in significant decreases on the Clinician Administered PTSD Scale and the PTSD Checklist-Military version for both groups. Also consistent with our hypothesis, significant decreases in social isolation occurred only for those participants who received the TMT group component. There were significant decreases for depression and anger for both groups, although these occurred after VRET and before group treatment. All treatment gains were maintained six-months later. Although not part of the original hypotheses, sleep was not improved by either intervention and remained problematic. The results support the use of VRET as an efficacious treatment for combat-related PTSD, but suggest that VRET alone does not result in optimal treatment outcomes across domains associated with PTSD.

Combat-related guilt and the mechanisms of exposure therapy.

Exposure therapy (EXP) is one of the most widely used and empirically supported treatments for PTSD; however, some researchers have questioned its efficacy with specific populations and in targeting specific symptoms. One such symptom, guilt, has garnered increased attention in the PTSD treatment literature, as it is associated with worse symptomatology and outcomes. The current study examined cognitive changes in guilt in response to Intensive (3-week) and Standard (17-week) Trauma Management Therapy (TMT), and the potential mechanisms underlying TMT treatment. TMT is an exposure based intervention that does not include an emotional processing component after the imaginal exposure session. A portion of the sample completed measures of guilt. As a result, sample size for these analyses ranged from 39 to 102 and varied by the domain and measure. Of the 102 individuals that completed the PTSD Checklist- Military Version, 42 completed the Trauma Related Guilt Inventory, and 39 completed the Clinician Administered PTSD Scale supplemental guilt items. Participants reported significant reductions in trauma-related guilt symptoms over the course of the TMT interventions. Greater reductions in avoidance and prior session general arousal predicted the reduction of guilt symptoms. Exposure therapy may be effective in reducing trauma-related guilt even in the absence of the emotional processing component of treatment.

A Functional Near-Infrared Spectroscopy Study of Trauma-Related Auditory and Olfactory Cues: Posttraumatic Stress Disorder or Combat Experience?

The prevalence of posttraumatic stress disorder (PTSD) among U.S. veterans deployed to Iraq or Afghanistan necessitates the need for comprehensive assessment and treatment strategies. This study investigated the utility of a combat-related PTSD symptom provocation paradigm to elicit unique neurological responses across three groups: combat veterans with PTSD, combat veterans without PTSD, and nonmilitary participants without PTSD. Using functional near-infrared spectroscopy (fNIRS) the results indicated that combat veterans with PTSD demonstrated significant activation to a trauma-related sound compared with nonmilitary personnel, channel 14: d = 1.03, 95% confidence interval (CI) [0.28, 1.76]; channel 15: d = 1.30, 95% CI [0.53, 2.06]; and combat veterans without PTSD, channel 14: d = 0.87, 95% CI [0.14, 1.59]. Specifically, this increased neural activation was approximately located in the right medial superior prefrontal cortex (Brodmann areas 9/10), an area associated with experiencing negative or threatening stimuli and emotional detachment. There were no differences across the groups for nontrauma-related sounds. Results were less clear with respect to a combat-related odor. These results suggest a specific neurophysiological response to trauma-related cues and, if replicated, may offer a biomarker for combat-related PTSD. Such a response could provide incremental validity over diagnostic assessments alone and assist in planning and monitoring of treatment outcome.

Team Resilience as a Second-Order Emergent State: A Theoretical Model and Research Directions.

Resilience has been recognized as an important phenomenon for understanding how individuals overcome difficult situations. However, it is not only individuals who face difficulties; it is not uncommon for teams to experience adversity. When they do, they must be able to overcome these challenges without performance decrements.This manuscript represents a theoretical model that might be helpful in conceptualizing this important construct. Specifically, it describes team resilience as a second-order emergent state. We also include research propositions that follow from the model.

REACT: A paraprofessional training program for first responders-A pilot study.

The purpose of this study was to evaluate a newly designed peer support training program for first responders titled Recognize, Evaluate, Advocate, Coordinate, and Track (REACT). REACT was developed in partnership with public safety agencies to address the need for promoting psychological health. This resulted in the development of a program that uses train-the-trainer methodology to address primary prevention of stress injuries. REACT was an all-day training that consisted of four modules, each featuring instruction and practice. Six public safety agencies totaling 30 individuals (76.9% from four fire departments, 23.1% from two emergency communication centers) participated in REACT. The primary outcomes were knowledge and training-related self-efficacy; secondary outcomes included general self-efficacy, resilience, and improved attitudes and expectations. A peer-support model, using a train-the-trainer methodology, is a promising approach for addressing the promotion of psychological health.

Making Games for Health Engaging: The Influence of Cognitive Skills.

OBJECTIVE: Serious games for health care are on the rise. These games are thought to be effective because they can provide information in a context that is engaging. However, it is likely that game-based health training is most effective for a subset of people with specific skills, traits, and experiences. Understanding the factors associated with optimum game outcomes will help us better describe the learners for whom they are appropriate. Toward this end, the present study examined specific cognitive skills related to the achievement of flow state while playing a game for health. MATERIALS AND METHODS: In total, 59 college students were recruited from undergraduate classes to play a game for health and were assessed on levels of mindfulness, cognitive flexibility, and flow state. RESULTS: The results suggest that the effect of cognitive flexibility on flow changes as a function of mindfulness. More specifically, the results suggest that there is a negative relationship between cognitive flexibility and flow in individuals low on mindfulness and a positive relationship between cognitive flexibility and flow in individuals high on mindfulness. CONCLUSIONS: Game designers wishing to create effective game-based treatment supplements may wish to implement cognitive flexibility and mindfulness training.

Stand-Alone Personalized Normative Feedback for College Student Drinkers: A Meta-Analytic Review, 2004 to 2014.

BACKGROUND: Norms clarification has been identified as an effective component of college student drinking interventions, prompting research on norms clarification as a single-component intervention known as Personalized Normative Feedback (PNF). Previous reviews have examined PNF in combination with other components but not as a stand-alone intervention. OBJECTIVES: To investigate the degree to which computer-delivered stand-alone personalized normative feedback interventions reduce alcohol consumption and alcohol-related harms among college students and to compare gender-neutral and gender-specific PNF. DATA SOURCES: Electronic databases were searched systematically through November 2014. Reference lists were reviewed manually and forward and backward searches were conducted. SELECTION CRITERIA: Outcome studies that compared computer-delivered, stand-alone PNF intervention with an assessment only, attention-matched, or active treatment control and reported alcohol use and harms among college students. METHODS: Between-group effect sizes were calculated as the standardized mean difference in change scores between treatment and control groups divided by pooled standard deviation. Within-group effect sizes were calculated as the raw mean difference between baseline and follow-up divided by pooled within-groups standard deviation. RESULTS: Eight studies (13 interventions) with a total of 2,050 participants were included. Compared to control participants, students who received gender-neutral (dbetween = 0.291, 95% CI [0.159, 0.423]) and gender-specific PNF (dbetween = 0.284, 95% CI [0.117, 0.451]) reported greater reductions in drinking from baseline to follow-up. Students who received gender-neutral PNF reported 3.027 (95% CI [2.171, 3.882]) fewer drinks per week at first follow-up and gender-specific PNF reported 3.089 (95% CI [0.992, 5.186]) fewer drinks. Intervention effects were small for harms (dbetween = 0.157, 95% CI [0.037, 0.278]). CONCLUSIONS: Computer-delivered PNF is an effective stand-alone approach for reducing college student drinking and has a small impact on alcohol-related harms. Effects are small but clinically relevant when considered from a public health perspective. Additional research is needed to examine computer-delivered, stand-alone PNF as a population-level prevention program.

Attitudes toward a game-based approach to mental health.

Based on preliminary research, game-based treatments appear to be a promising approach to post-traumatic stress disorder (PTSD). However, attitudes toward this novel approach must be better understood. Thus, the objective of this study was to determine if video game self-efficacy mediates the relationship between expectations and reactions to a game-based treatment for PTSD. Participants played the serious game "Walk in My Shoes" (Novonics Corp., Orlando, FL) and completed a series of scales to measure attitudes toward the intervention. Video game self-efficacy was found to be a partial mediator of expectancies and reactions. These results suggest that enhancing attitudes via self-efficacy in a clinical setting may maximize treatment effectiveness.

The Role of Expectations in Game-Based Training.

The present work seeks to examine the importance of expectancies in computer-mediated treatment and training programs. Two studies examining the role of patient and trainee expectations are presented. Study 1 investigated how expectations of a training game for military surgical teams influence training performance outcomes. The findings have implications for the administration of game-based treatment and training systems. Study 2 explored how pre-treatment expectancies influence post-treatment reactions to a game-based intervention for post-traumatic stress disorder (PTSD). Results indicate that self-efficacy plays a mediating role in the relationship between expectancies and reactions. Together, these studies offer implications regarding the critical role of attitudes towards game-based training and treatment mechanisms.