SafeVRwards: Designing a complementary virtual reality module to the Safewards framework intended to relax and manage conflict in mental health wards.

BACKGROUND: Aggression and negative activation in mental health inpatient units pose significant challenges for both patients and staff with severe physical and psychological ramifications. The Safewards model is an evidence-based conflict-containment framework including 10 strategies, such as 'Calm Down Methods'. As virtual reality (VR) scenarios have successfully enhanced anxiolytic and deactivating effects of therapeutic interventions, they are increasingly considered a means to enhance current models, like Safewards. OBJECTIVES: The present participatory design investigates the feasibility and user experience of integrating VR therapy as an add-on strategy to the Safewards model, gathering preliminary data and qualitative feedback from bedside staff in an adult inpatient mental health unit. METHODS: An exploratory within-subjects design combining qualitative observations, self-report questionnaires and semistructured interviews is employed with four nurse champions from the mental health unit at Michael Garron Hospital (Toronto, Canada). RESULTS: A chronological overview of the design process, adaptations and description of the user experience is reported. CONCLUSION: 'SafeVRwards' introduces VR as a promising conflic-containment strategy complementary to the Safewards model, which can be optimised for deployment through user-oriented refinements and enhanced customisation capacity driven by clinical staff input.

A spatial version of the Stroop task for examining proactive and reactive control independently from non-conflict processes.

Conflict-induced control refers to humans' ability to regulate attention in the processing of target information (e.g., the color of a word in the color-word Stroop task) based on experience with conflict created by distracting information (e.g., an incongruent color word), and to do so either in a proactive (preparatory) or a reactive (stimulus-driven) fashion. Interest in conflict-induced control has grown recently, as has the awareness that effects attributed to those processes might be affected by conflict-unrelated processes (e.g., the learning of stimulus-response associations). This awareness has resulted in the recommendation to move away from traditional interference paradigms with small stimulus/response sets and towards paradigms with larger sets (at least four targets, distractors, and responses), paradigms that allow better control of non-conflict processes. Using larger sets, however, is not always feasible. Doing so in the Stroop task, for example, would require either multiple arbitrary responses that are difficult for participants to learn (e.g., manual responses to colors) or non-arbitrary responses that can be difficult for researchers to collect (e.g., vocal responses in online experiments). Here, we present a spatial version of the Stroop task that solves many of those problems. In this task, participants respond to one of six directions indicated by an arrow, each requiring a specific, non-arbitrary manual response, while ignoring the location where the arrow is displayed. We illustrate the usefulness of this task by showing the results of two experiments in which evidence for proactive and reactive control was obtained while controlling for the impact of non-conflict processes.

Tracing conflict-induced cognitive-control adjustments over time using aperiodic EEG activity.

Cognitive-control theories assume that the experience of response conflict can trigger control adjustments. However, while some approaches focus on adjustments that impact the selection of the present response (in trial N), other approaches focus on adjustments in the next upcoming trial (N + 1). We aimed to trace control adjustments over time by quantifying cortical noise by means of the fitting oscillations and one over f algorithm, a measure of aperiodic activity. As predicted, conflict trials increased the aperiodic exponent in a large sample of 171 healthy adults, thus indicating noise reduction. While this adjustment was visible in trial N already, it did not affect response selection before the next trial. This suggests that control adjustments do not affect ongoing response-selection processes but prepare the system for tighter control in the next trial. We interpret the findings in terms of a conflict-induced switch from metacontrol flexibility to metacontrol persistence, accompanied or even implemented by a reduction of cortical noise.

[Associations between Personality Structure, Psychodynamic Conflicts and Defense Styles in Adolescents with Mental Health Problems]. / Die Zusammenhänge von psychischer Struktur, psychodynamischen Konflikten und Abwehrstilen bei Adoleszenten mit psychischen Beschwerden.

OBJECTIVES: An exploration of the interrelationships between central psychodynamic constructs in adolescents with mental health problems was conducted. METHODS: 230 adolescents (Mage=18.0±1.9) were assessed using the Structure and the Conflict Questionnaire of the Operationalized Psychodynamic Diagnosis System in Childhood and Adolescence and the Defense Style Questionnaire for Adolescents. RESULTS: Controlling for the influence of gender, age, and socioeconomic status, low to moderate associations were revealed between increased psychodynamic conflict levels and immature defense styles (r=0.20 to 0.39, p<0.05 to 0.001) as wells as deficits in the personality structure and increased psychodynamic conflict levels (r=0.15 to 0.55, p<0.05 to p<0.001) or immature defense styles (r=0.30 to 0.69, p<0.001). Psychodynamic conflicts as well as defense styles could be predicted by the structural dimensions as well as age and sex (R2=0 .04 to 0.49, p<0.05 to 0.001). CONCLUSIONS: Theory-compliant correlations were demonstrated. The findings are particularly relevant against the background of the revision of the classification of personality functioning (ICD-11) in childhood and adolescence.

Perceiving greater variety among past conflicts with a focal goal reduces expected goal conflict.

Many important personal goals, such as health, career, finances, and social relationships, entail repeatedly performing the same (or similar) actions over time (e.g., to exercise daily or save money weekly). When pursuing such ongoing goals, people are likely to accumulate multiple experiences of goal conflict (e.g., multiple occasions when one failed to exercise or save as intended). How might these past experiences of goal conflict inform expectations about future goal pursuit? This research examines how the perceived relationship among past conflicts with a focal goal-in particular, perceived variety-shapes expectations. Perceived variety refers to the holistic assessment of differentiation (vs. similarity) among items in an assortment. Six studies demonstrate that perceiving greater variety among past conflicts with a focal goal decreases expectations of encountering conflict in the future. This occurs because perceiving greater variety makes the causes of past events seem collectively unstable (i.e., more temporary and one-off). Consequently, holding constant the number and content of past events, perceiving greater variety among past conflicts with a focal goal reduces expected goal conflict. Further, considering past events that prompt (i.e., motivate) less (vs. more) engagement in causal search (i.e., events that are less self-relevant, or positive) attenuates perceived variety's effects. The findings contribute to understanding of goal conflict, variety and similarity, and forecasting in goal pursuit. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

On being unpredictable and winning.

In theory, it can be strategically advantageous for competitors to make themselves unpredictable to their opponents, for example, by variably mixing hostility and friendliness. Empirically, it remains open whether and how competitors make themselves unpredictable, why they do so, and how this conditions conflict dynamics and outcomes. We examine these questions in interactive attacker-defender contests, in which attackers invest to capture resources held and defended by their opponent. Study 1, a reanalysis of nine (un)published experiments (total N = 650), reveals significant cross-trial variability especially in proactive attacks and less in reactive defense. Study 2 (N = 200) shows that greater variability makes both attacker's and defender's next move more difficult to predict, especially when variability is due to occasional rather than (in)frequent extreme investments in conflict. Studies 3 (N = 27) and 4 (N = 106) show that precontest testosterone, a hormone associated with risk-taking and status competition, drives variability during attack which, in turn, increases sympathetic arousal in defenders and defender variability (Study 4). Rather than being motivated by wealth maximization, being unpredictable in conflict and competition emerges in function of the attacker's desire to win "no matter what" and comes with significant welfare cost to both victor and victim. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Response stopping under conflict: The integrative role of representational dynamics associated with the insular cortex.

Coping with distracting inputs during goal-directed behavior is a common challenge, especially when stopping ongoing responses. The neural basis for this remains debated. Our study explores this using a conflict-modulation Stop Signal task, integrating group independent component analysis (group-ICA), multivariate pattern analysis (MVPA), and EEG source localization analysis. Consistent with previous findings, we show that stopping performance is better in congruent (nonconflicting) trials than in incongruent (conflicting) trials. Conflict effects in incongruent trials compromise stopping more due to the need for the reconfiguration of stimulus-response (S-R) mappings. These cognitive dynamics are reflected by four independent neural activity patterns (ICA), each coding representational content (MVPA). It is shown that each component was equally important in predicting behavioral outcomes. The data support an emerging idea that perception-action integration in action-stopping involves multiple independent neural activity patterns. One pattern relates to the precuneus (BA 7) and is involved in attention and early S-R processes. Of note, three other independent neural activity patterns were associated with the insular cortex (BA13) in distinct time windows. These patterns reflect a role in early attentional selection but also show the reiterated processing of representational content relevant for stopping in different S-R mapping contexts. Moreover, the insular cortex's role in automatic versus complex response selection in relation to stopping processes is shown. Overall, the insular cortex is depicted as a brain hub, crucial for response selection and cancellation across both straightforward (automatic) and complex (conditional) S-R mappings, providing a neural basis for general cognitive accounts on action control.

Reducing decisional conflict in decisions about prenatal genetic testing: the impact of a dyadic intervention at the start of prenatal care.

OBJECTIVES: Decisional conflict and regret about prenatal genetic screening and diagnostic tests may have important consequences in the current pregnancy and for future reproductive decisions. Identifying mechanisms that reduce conflict associated with the decision to use or decline these options is necessary for optimal patient counseling. METHODS: We conducted a cluster-randomized controlled trial of a shared decision-making tool (NEST) at the beginning of prenatal care. Enrolled patients completed follow-up surveys at the time of testing (QTT) and in the second-third trimester (QFF), including the Decision Conflict Scale (DCS). Total DCS scores were analyzed using a multivariate linear mixed-effect model. RESULTS: Of the total number of participants (n=502) enrolled, 449 completed the QTT and QFF surveys. The mean age of participants was 31.6±3.8, with most parous at the time of study participation (n=321; 71.7 %). Both the NEST (the intervention) and control groups had lower median total DCS scores at QFF (NEST 13.3 [1.7, 25.0] vs. control 16.7 [1.7, 25.0]; p=0.24) compared to QTT (NEST 20.8 [5.0, 25.0] vs. control 18.3 [3.3, 26.7]; p=0.89). Participants exposed to NEST had lower decisional conflict at QFF compared to control (ß -3.889; [CI -7.341, -0.437]; p=0.027). CONCLUSIONS: Using a shared decision-making tool at the start of prenatal care decreased decisional conflict regarding prenatal genetic testing. Such interventions have the potential to provide an important form of decision-making support for patients facing the unique type of complex and preference-based choices about the use of prenatal genetic tests.

Humans do not avoid reactively implementing cognitive control.

The ability to exert cognitive control allows us to achieve goals in the face of distraction and competing actions. However, control is costly-people generally aim to minimize its demands. Because control takes many forms, it is important to understand whether such costs apply universally. Specifically, reactive control, which is recruited in response to stimulus or contextual features, is theorized to be deployed automatically, and not depend on attentional resources. Here, we investigated whether people avoided implementing reactive control in three experiments. In all, participants performed a Stroop task in which certain items were mostly incongruent (MI), that is, associated with a high likelihood of conflict (triggering a focused control setting). Other items were mostly congruent, that is, associated with a low likelihood of conflict (triggering a relaxed control setting). Experiment 1 demonstrated that these control settings transfer to a subsequent unbiased transfer phase. In Experiments 2-3, we used a demand selection task to investigate whether people would avoid choice options that yielded items that were previously MI. In all, participants continued to retrieve focused control settings for previously MI items, but they did not avoid them in the demand selection task. Critically, we only found demand avoidance when there was an objective difference in demand between options. These findings are consistent with the idea that implementing reactive control does not register as costly. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Important Role of the Right Dorsolateral Prefrontal Cortex in Conflict Adaptation: A Combined Voxel-Based Morphometry and Continuous Theta Burst Stimulation Study.

Humans can flexibly adjust their executive control to resolve conflicts. Conflict adaptation and conflict resolution are crucial aspects of conflict processing. Functional neuroimaging studies have associated the dorsolateral prefrontal cortex (DLPFC) with conflict processing, but its causal role remains somewhat controversial. Moreover, the neuroanatomical basis of conflict processing has not been thoroughly examined. In this study, the Stroop task, a well-established measure of conflict, was employed to investigate (1) the neuroanatomical basis of conflict resolution and conflict adaptation with the voxel-based morphometry analysis, (2) the causal role of DLPFC in conflict processing with the application of the continuous theta burst stimulation to DLPFC. The results revealed that the Stroop effect was correlated to the gray matter volume of the precuneus, postcentral gyrus, and cerebellum, and the congruency sequence effect was correlated to the gray matter volume of superior frontal gyrus, postcentral gyrus, and lobule paracentral gyrus. These findings indicate the neuroanatomical basis of conflict resolution and adaptation. In addition, the continuous theta burst stimulation over the right DLPFC resulted in a significant reduction in the Stroop effect of RT after congruent trials compared with vertex stimulation and a significant increase in the Stroop effect of accuracy rate after incongruent trials than congruent trials, demonstrating the causal role of right DLPFC in conflict adaptation. Moreover, the DLPFC stimulation did not affect the Stroop effect of RT and accuracy rate. Overall, our study offers further insights into the neural mechanisms underlying conflict resolution and adaptation.

EEG complexity in emotion conflict task in individuals with psychiatric disorders.

Analyzing EEG complexity may help to elucidate complex brain dynamics in individuals with psychiatric disorders and provide insight into neural connectivity and its relationship with deficits such as emotion-related impulsivity. EEG complexity was calculated through multiscale entropy and compared between a heterogeneous psychiatric patient group and a healthy control group during the emotion conflict resolution task. Twenty-eight healthy adults and ten psychiatric patients were recruited and compared on the multiscale entropy of EEG acquired in the task. Our results revealed a lower multiscale entropy in the psychiatric patient group compared to the healthy group during the task. This decrease in multiscale entropy suggests reduced long-range interaction between the left frontal region and other brain regions during the emotion conflict resolution task among psychiatric patients. Notably, a positive correlation was observed between multiscale entropy and impulsivity measures in the psychiatric patient group, where the higher the EEG complexity during the emotion regulation task, the higher the level of self-reported impulsivity in the psychiatric patients. Such impulsivity was evident in both healthy individuals and psychiatric patients, with healthy individuals showing shorter reaction times on incongruent conditions compared to congruent conditions and psychiatric patients displaying similar reaction times in both conditions, This study highlights the significance of investigating EEG complexity and its potential applications in the transdiagnostic exploration of impulsivity in psychiatric disorders.

On subjective measures of decision quality.

In times of person-centered care, it is all the more important to support patients in making good decisions about their care. One way to offer such support to patients is by way of Patient Decision Aids (PDAs). Ranging from patient brochures to web-based tools, PDAs explicitly state the decisions patients face, inform them about their medical options, help them to clarify and discuss their values, and ultimately make a decision. However, lingering discussions surround effectiveness research on PDAs. In this article, I focus on two subjective measures of decision quality that are widely used as outcome measures in effectiveness research on PDAs (i.e., the Decisional Conflict Scale (DCS) and measures of regret). Although these measurement instruments have attracted critical attention in the scientific literature, bioethicists have hardly engaged with them. Therefore, I set myself to analyze the relationship between (the different subscales of) the DCS and measures of regret, on the one hand, and ethical principles such as beneficence and autonomy, on the other hand. In light of that analysis, I will clarify some discussions regarding the use of these measures of decision quality in effectiveness research on PDAs. This should help us to align the way we evaluate PDAs with ethical principles and avoid that our attempts to support patients in making good decisions about their care that is so central to person-centered care point in unethical directions.

Cross-modal conflict deficit in children with attention-deficit/hyperactivity disorder.

The difference between the audiovisual incongruent condition and the audiovisual congruent condition is known as cross-modal conflict, which is an important behavioral index to measure the conflict control function. Previous studies have found conflict control deficits in children with attention-deficit/hyperactivity disorder (ADHD), but it is not clear whether and how cross-modal conflict occurs in children with ADHD at different processing levels. The current study adopted the cross-modal matching paradigm to recruit 25 children with ADHD (19 boys and 6 girls) and 24 TD children (17 boys and 7 girls), aiming to investigate the cross-modal conflict effect at the perception and response levels of children with ADHD. The results showed that both groups of children showed significant cross-modal conflict, and there was no significant difference between the ADHD and TD groups in the number of error trials and mean response time. However, the cross-modal conflict effect caused by auditory distractors was different between the ADHD and TD groups; the TD group had stronger auditory conflict at the response level, whereas the ADHD group had weaker auditory conflict. This indicates that the ADHD group had a deficit of auditory conflict at the response level.

Prefrontal-subthalamic theta signaling mediates delayed responses during conflict processing.

While medial frontal cortex (MFC) and subthalamic nucleus (STN) have been implicated in conflict monitoring and action inhibition, respectively, an integrated understanding of the spatiotemporal and spectral interaction of these nodes and how they interact with motor cortex (M1) to definitively modify motor behavior during conflict is lacking. We recorded neural signals intracranially across presupplementary motor area (preSMA), M1, STN, and globus pallidus internus (GPi), during a flanker task in 20 patients undergoing deep brain stimulation implantation surgery for Parkinson disease or dystonia. Conflict is associated with sequential and causal increases in local theta power from preSMA to STN to M1 with movement delays directly correlated with increased STN theta power, indicating preSMA is the MFC locus that monitors conflict and signals STN to implement a 'break.' Transmission of theta from STN-to-M1 subsequently results in a transient increase in M1-to-GPi beta flow immediately prior to movement, modulating the motor network to actuate the conflict-related action inhibition (i.e., delayed response). Action regulation during conflict relies on two distinct circuits, the conflict-related theta and movement-related beta networks, that are separated spatially, spectrally, and temporally, but which interact dynamically to mediate motor performance, highlighting complex parallel yet interacting networks regulating movement.

Examining the reliability of the emotional conflict resolution and adaptation effects in the emotional conflict task via secondary data analysis, systematic review, and meta-analysis.

The emotional conflict task measures emotional conflict resolution and adaptation, but some studies are unable to find resolution or adaptation effects using this task. We examined boundary conditions and replicability of the emotional conflict resolution and adaptation effects through secondary data analysis, systematic review, and meta-analysis of studies in the field. In our data, we were unable to fully replicate the emotional conflict resolution or adaptation effects and found that most studies using this task (n = 94) do not report analysis of emotional conflict resolution, with only 28% (n = 26) studies doing so. Our meta-analysis suggests that studies reporting emotional conflict resolution and adaptation analyses overall report significant but small effects, suggesting the effect is difficult to consistently replicate. Our meta-analysis revealed that controlling for contingency learning may impact the ability of studies to identify conflict resolution. These findings have implications for assessment and interpretation of the emotional conflict task. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Action control costs in task selection: Agents avoid actions with incompatible movement and effect features.

When a movement triggers effects with incompatible features, conflict between action and effect features creates costs for action planning and initiation. We investigated whether such action control costs also factor into action choices in terms of the principle of least effort. Participants completed a reaction-time experiment, where they were instructed to perform left and right mouse swipes in response to directional cues presented on the screen. Participants could select between two action options on each trial: Depending on which part of the screen (upper or lower) the action was performed in, the swipe resulted in a visual stimulus moving in the same (compatible) or in the opposite (incompatible) direction as the mouse. Incompatible action-effect mappings did indeed incur action control costs. In accordance with effort avoidance, the proportion of compatible choices was significantly above chance level, suggesting that action selection and initiation costs factor into participants preferences. Interestingly, however, participants' choice tendencies were not predicted by the actual increase in action-initiation costs in the incompatible condition. This indicates that effort-related decisions are not simply based on monitoring performance in the actual task, but they are also influenced by preestablished notions of action-planning costs.

The neural dynamics of conflict adaptation induced by conflict observation: Evidence from univariate and multivariate analysis.

Conflict adaptation can be expressed as greater performance (shorter response time and lower error rate) after incongruent trials when compared to congruent trials. It has been observed in designs that minimize confounding factors, i.e., feature integration, contingency learning, and temporal learning. Our current study aimed to further elucidate the temporal evolution mechanisms of conflict adaptation. To address this issue, the current study employed a combination of behavioral, univariate, and multivariate analysis (MVPA) methods in a modified color-word Stroop task, where half of the trials required button presses (DO trials), and the other half only required observation (LOOK trials). Both behavioral and the ERP results (N450 and SP) in the LOOK-DO transition trials revealed significant conflict adaptation without feature integration, contingency learning, and temporal learning, providing support for the conflict monitoring theory. Furthermore, during the LOOK trials, significant Stroop effect in the N450 and SP components were observed, indicating that conflict monitoring occurred at the stimulus level and triggered reactive control adjustments. The MVPA results decoded the congruent-incongruent and incongruent-incongruent conditions during the conflict adjustment phase but not during the conflict monitoring phase, emphasizing the unique contribution of conflict adjustment to conflict adaptation. The current research findings provided more compelling supporting evidence for the conflict monitoring theory, while also indicating that future studies should employ the present design to elucidate the specific processes of conflict adaptation.

Orthogonal neural encoding of targets and distractors supports multivariate cognitive control.

The complex challenges of our mental life require us to coordinate multiple forms of neural information processing. Recent behavioural studies have found that people can coordinate multiple forms of attention, but the underlying neural control process remains obscure. We hypothesized that the brain implements multivariate control by independently monitoring feature-specific difficulty and independently prioritizing feature-specific processing. During functional MRI, participants performed a parametric conflict task that separately tags target and distractor processing. Consistent with feature-specific monitoring, univariate analyses revealed spatially segregated encoding of target and distractor difficulty in the dorsal anterior cingulate cortex. Consistent with feature-specific attentional priority, our encoding geometry analysis revealed overlapping but orthogonal representations of target and distractor coherence in the intraparietal sulcus. Coherence representations were mediated by control demands and aligned with both performance and frontoparietal activity, consistent with top-down attention. Together, these findings provide evidence for the neural geometry necessary to coordinate multivariate cognitive control.

Balancing the Senses: Electrophysiological Responses Reveal the Interplay between Somatosensory and Visual Processing During Body-Related Multisensory Conflict.

In the study of bodily awareness, the predictive coding theory has revealed that our brain continuously modulates sensory experiences to integrate them into a unitary body representation. Indeed, during multisensory illusions (e.g., the rubber hand illusion, RHI), the synchronous stroking of the participant's concealed hand and a fake visible one creates a visuotactile conflict, generating a prediction error. Within the predictive coding framework, through sensory processing modulation, prediction errors are solved, inducing participants to feel as if touches originated from the fake hand, thus ascribing the fake hand to their own body. Here, we aimed to address sensory processing modulation under multisensory conflict, by disentangling somatosensory and visual stimuli processing that are intrinsically associated during the illusion induction. To this aim, we designed two EEG experiments, in which somatosensory- (SEPs; Experiment 1; N = 18; F = 10) and visual-evoked potentials (VEPs; Experiment 2; N = 18; F = 9) were recorded in human males and females following the RHI. Our results show that, in both experiments, ERP amplitude is significantly modulated in the illusion as compared with both control and baseline conditions, with a modality-dependent diametrical pattern showing decreased SEP amplitude and increased VEP amplitude. Importantly, both somatosensory and visual modulations occur in long-latency time windows previously associated with tactile and visual awareness, thus explaining the illusion of perceiving touch at the sight location. In conclusion, we describe a diametrical modulation of somatosensory and visual processing as the neural mechanism that allows maintaining a stable body representation, by restoring visuotactile congruency under the occurrence of multisensory conflicts.

Conflict in moral and nonmoral decision making: an empirical study coupled with a computational model.

While moral psychology research has extensively studied decision making using moral dilemmas, such high-conflict situations may not fully represent all moral decisions. Moreover, most studies on the effect of conflict have focused on nonmoral decisions, and it is unclear how it applies to the moral realm. The present mixed-method research investigates how conflict impacts moral compared to nonmoral decision making. In a preregistered empirical study ( N = 42 ), participants made moral and nonmoral decisions with varying levels of conflict while their mouse trajectories were recorded. Results indicate that moral decisions were more stable in the presence of conflict, while still seeking compromise. In addition, decisions were more affected when conflict got higher. Mouse-tracking data further indicate that some factors are impacting the decision process earlier than others, supporting the relevance of tracing methods to dig into finer-grained decision dynamics. We also present a computational model that aims to capture decision mechanisms and how conflict and morality influence decision making. The model uses dynamic neural fields coupled with sensorimotor control to map a continuous decision space. Two model versions were compared: one with greater perceptual weight for moral information, and another with earlier processing of moral versus nonmoral information. The simulated data more successfully reproduced empirical patterns for the second version, thus providing insights into the underlying decision processes for both moral and nonmoral decisions, in the presence of conflict or not.