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Gamification: a Novel Approach to Mental Health Promotion.
PURPOSE OF REVIEW: Gamification has emerged as a novel technique for improving mental health and enhancing treatment effectiveness. This paper provides an overview of gamification approaches to mental health intervention, identifies factors that may be related to variations in treatment effectiveness, and discusses possible strategies for tailoring gamified interventions to clients' needs. RECENT FINDINGS: Recent research has documented the potential of gamified mental health interventions for bolstering mental wellness and mitigating psychological symptoms. However, their effectiveness may vary depending on study design-related factors and gender-specific considerations. Literature reviews have also identified yet-to-be resolved issues surrounding the possible strengths and weaknesses of the personalization versus standardization of gamification, as well as the potential benefits of gamification for increasing engagement versus the potential risks of over-engagement and behavioral addiction to gamified components. This review highlights the need for careful planning and execution of gamified mental health interventions to optimize their effectiveness and suitability for meeting clients' individual needs and preferences.
Using network models to explore the associations between posttraumatic stress disorder symptoms and subjective cognitive functioning.
Several studies have identified relationships between posttraumatic stress disorder (PTSD) and cognitive functioning. Here, we aimed to elucidate the nature of this relationship by investigating cross-sectional associations between subjective cognitive functioning (SCF) and 1) the PTSD sum score, 2) symptom domains, and 3) individual symptoms. We also investigated temporal stability by testing whether results replicated over a 3-year period. We estimated partial correlation networks of DSM-5 PTSD symptoms (at baseline) and SCF (at baseline and follow-up, respectively), using data from the National Health and Resilience in Veterans Study (NHRVS; N = 1484; Mdn = 65 years). The PTSD sum score was negatively associated with SCF. SCF was consistently negatively associated with the PTSD symptom domains 'marked alterations in arousal and reactivity' and 'negative alterations in cognitions and mood', and showed robust relations with the specific symptoms 'having difficulty concentrating' and 'trouble experiencing positive feelings'. Results largely replicated at the 3-year follow-up, suggesting that some PTSD symptoms both temporally precede and are statistically associated with the development or maintenance of reduced SCF. We discuss the importance of examining links between specific PTSD domains and symptoms with SCF-relations obfuscated by focusing on PTSD diagnoses or sum scores-as well as investigating mechanisms underlying these relations. Registration Number: 37069 (https://aspredicted.org/n5sw7.pdf).
Fear of giving birth alone: Experiences of psychological distress, symptoms of anxiety and depression, and coping- strategies of childbearing women during COVID-19.
BACKGROUND: Psychological distress during pregnancy is a well-documented risk factor for adverse maternal outcomes. Distress related to the COVID-19 pandemic may further increase the vulnerability of pregnant women to negative mental health outcomes. AIM: To explore the mental health experiences of pregnant women, focusing on mental health outcomes, challenges related to the pandemic, coping strategies, and factors buffering mental health factors during the restricted COVID-19 lockdown period. METHODS: A mixed-methods survey study was conducted, examining symptoms of anxiety, depression, and burnout among 21 pregnant women. Qualitative data were gathered through open-ended questions about participants' experiences of challenges, coping strategies and buffering factors amid the pandemic. Symptoms of anxiety, depression and burnout were calculated, and qualitative data was thematically analyzed. RESULTS: Approximately one-third (24 %) of the respondents reported clinically significant levels of depression, 19 % reported clinically significant levels of anxiety, and 43 % reported experiencing burnout. All participants reported distress and emotional burden, including fear, worry, stress and anxiety related to the pandemic. Specific concerns such as fear of giving birth alone, fear of the consequences due to lockdown restrictions, insufficient information, disruption of prenatal healthcare services, and fear of miscarriage were prevalent among the participants. Social support, financial stability, stable relationships, adherence to daily routines, reduced stress and social demands, a calmer daily life, physical activity, and less work-related stress including working from home, emerges as buffering factors that aided women in coping with pandemic-related distress. CONCLUSION: Healthcare providers should prioritize stability, predictability, and minimizing disruptions to prenatal care. Broad-based screening is crucial to identify women at risk of depression, anxiety, and burnout. Recommendations for clinical pathways aimed at pregnant women are discussed.
Daily dynamics and mechanisms of anxious symptomatology in the general population: A network study during the COVID-19 pandemic.
To understand the interplay between anxiety symptoms and their maintaining psychological processes in the population, an analysis of longitudinal within-person relationships is required. A sample of 1706 individuals completed daily measures during a 40-day period with strict mitigation protocols. Data of 1368 individuals who completed at least 30 assessments were analyzed with the multilevel vector autoregressive (mlVAR) model. This model estimates a temporal, a contemporaneous, and a between-person network. Uncontrollability of worry, generalized worry, fear of being infected, fear of significant others being infected, and threat monitoring had the highest outstrength within the temporal network, indicating that daily fluctuations in these components were the most predictive of next-day fluctuations in other components. Of specific connections, both fear of self and fear of close others being infected predicted generalized worry and threat monitoring. In turn, generalized worry and threat monitoring engaged in several positive feedback loops with other anxiety symptoms and processes. Also, intolerance of uncertainty was predictive of other components. The findings align with the mechanisms both in the metacognitive therapy (MCT) model and in the intolerance of uncertainty model of generalized anxiety disorder (GAD).
Insomnia Symptoms in the General Population During the COVID-19 Pandemic
This empirical study aims to investigate factors associated with insomnia symptoms during the COVID-19 pandemic in 4,921 Norwegian adults. Participants were queried across two time-points, between March 31st and April the 7th 2020, and between June 22nd and July 13th, 2020. Relevant risk factors and psychological correlates at the first time-point and insomnia symptoms were measured 3 months later, allowing for the investigation of concurrent associations as well as associations across time. Insomnia symptoms were measured with the Bergen Insomnia Scale. The results revealed that individuals reported higher mean levels of insomnia symptoms during the COVID-19 lockdown, compared to pre-pandemic surveys from 2008 (p < 0.0001, Cohen's d = 0.29). Individuals who predominantly socially distanced reported higher mean levels of insomnia symptoms than those who did not predominantly distance. Females, individuals with lower education levels, individuals who had lost their job, and individuals who declared having been diagnosed with an unspecified pre-existing psychiatric disorder reported the most symptoms. The regression model (R2 = 0.44) showed that physical exercise, was associated with less symptoms of insomnia. Symptoms of health Anxiety, symptoms of depression, unhelpful coping strategies, worry about job and economy, and older age were all associated with higher levels of insomnia symptoms. These findings highlight particularly vulnerable subgroups, as well as providing clinicians with key areas of intervention to help individuals suffering from insomnia symptoms.
Symptomatology, risk, and protective factors of gaming disorder: A network analytical approach
Research has identified various cognitive risk and protective (CRP) factors that contribute to gaming disorder (GD), but it remains unclear how GD symptoms are differentially related to specific CRP factors. To fill the gap, this study used network analysis to identify the most central components in the connections between CRP factors and GD symptoms, shedding light on the most important factors for the development and maintenance of GD. The participants of this study were 3002 adult online gamers (49.8% men, mean age = 36.3 years). Two unregularized Gaussian graphical models were estimated, one that only included GD symptoms and another that included both GD symptoms and CRP factors. The findings showed that “cognitive flexibility”, “gaming self-esteem”, and “loss of control” were the most central cognitive protective factor, cognitive risk factor, and GD symptom, respectively. Moreover, the GD symptom of “escape”, the cognitive risk factor of “loss sensitivity”, and the cognitive protective factor of “cognitive flexibility” were most prominent in bridging different constructs, reflecting two mechanistic clusters of GD: escapism and reward-seeking. The findings further revealed that the cognitive risk factor of “maladaptive gaming cognition” was closely connected to GD symptoms, indicating its influential role as a harmful mechanism underlying GD. Overall, our network analysis indicates that having secure self-beliefs and situation-based flexibility may be crucial for healthy gaming.
Triggered by worry: A dynamic network analysis of COVID-19 pandemic-related anxiety and parental stress.
BACKGROUND: Major disruptions to daily life routines made families and parents particularly vulnerable to psychological distress during the COVID-19 lockdowns. However, the specific psychopathological processes related to within-person variation and maintenance of anxiety symptomatology and parental distress components in the parental population have been largely unexplored in the literature. METHODS: In this preregistered intensive longitudinal study, a multilevel dynamic network was used to model within-person interactions between anxiety symptomatology, psychopathological processes, parental distress, and protective lifestyle components in a sample of 495 parents-each responding to daily assessments over a 40-day period. A total of 30,195 observations were collected across the subjects. RESULTS: Extensive worry, threat monitoring, and uncontrollability of worry were identified as overreaching psychopathological processes related to the aggravation of other symptoms of anxiety and parental distress. A strong association was found between parental stress and parental burnout. Anger toward one's child was associated with both parental stress and parental burnout. Protective factors showed the lowest strength centrality, with few and weak connections to other symptoms and processes in the network. LIMITATIONS: Associations may exist between the study variables on a different time scale; hence, different time lags should be used in future research. CONCLUSIONS: Accessible, low-cost interventions that address worry, threat monitoring, and the uncontrollability of worry could serve as potential targets for reducing the symptom burden of anxiety and distress in the parental population.
Comparing the Oxford Digital Multiple Errands Test (OxMET) to a real-life version: Convergence, feasibility, and acceptability.
We aimed to assess the convergence, feasibility, and acceptability of the Oxford Digital Multiple Errands Test (OxMET) and the in-person Multiple Errands Test-Home version (MET-Home). Participants completed OxMET, MET-Home, Montreal Cognitive Assessment (MoCA), and questionnaires on activities of daily living, depression, technology usage, mobility, and disability. Forty-eight stroke survivors (mean age 69.61, 41.67% female, and average 16.5 months post-stroke) and 50 controls (mean age 71.46, 56.00% female) took part. No performance differences were found for healthy and stroke participants for MET-Home, and only found below p = .05 for OxMET but not below the corrected p = .006. Convergent validity was found between MET-Home and OxMET metrics (most r ≥ .30, p
Nature and human well-being: The olfactory pathway.
The world is undergoing massive atmospheric and ecological change, driving unprecedented challenges to human well-being. Olfaction is a key sensory system through which these impacts occur. The sense of smell influences quality of and satisfaction with life, emotion, emotion regulation, cognitive function, social interactions, dietary choices, stress, and depressive symptoms. Exposures via the olfactory pathway can also lead to (anti-)inflammatory outcomes. Increased understanding is needed regarding the ways in which odorants generated by nature (i.e., natural olfactory environments) affect human well-being. With perspectives from a range of health, social, and natural sciences, we provide an overview of this unique sensory system, four consensus statements regarding olfaction and the environment, and a conceptual framework that integrates the olfactory pathway into an understanding of the effects of natural environments on human well-being. We then discuss how this framework can contribute to better accounting of the impacts of policy and land-use decision-making on natural olfactory environments and, in turn, on planetary health.
The future of psychological treatments: The Marburg Declaration.
Although psychological treatments are broadly recognized as evidence-based interventions for various mental disorders, challenges remain. For example, a substantial proportion of patients receiving such treatments do not fully recover, and many obstacles hinder the dissemination, implementation, and training of psychological treatments. These problems require those in our field to rethink some of our basic models of mental disorders and their treatments, and question how research and practice in clinical psychology should progress. To answer these questions, a group of experts of clinical psychology convened at a Think-Tank in Marburg, Germany, in August 2022 to review the evidence and analyze barriers for current and future developments. After this event, an overview of the current state-of-the-art was drafted and suggestions for improvements and specific recommendations for research and practice were integrated. Recommendations arising from our meeting cover further improving psychological interventions through translational approaches, improving clinical research methodology, bridging the gap between more nomothetic (group-oriented) studies and idiographic (person-centered) decisions, using network approaches in addition to selecting single mechanisms to embrace the complexity of clinical reality, making use of scalable digital options for assessments and interventions, improving the training and education of future psychotherapists, and accepting the societal responsibilities that clinical psychology has in improving national and global health care. The objective of the Marburg Declaration is to stimulate a significant change regarding our understanding of mental disorders and their treatments, with the aim to trigger a new era of evidence-based psychological interventions.
Inhaled pentamidine and prevention of pneumocystis pneumonia
To the Editor: In the report of the recent European controlled trial of inhaled pentamidine for prophylaxis against Pneumocystis carinii pneumonia (PCP), Hirschel and colleagues (April 18 issue)1 state that it appears that prophylaxis against PCP may be less expensive than treating this disease. On the basis of data from the United States, there are several reasons why inhaled pentamidine is unlikely to reduce costs in this country. First, its cost is $100 to $129 per 300-mg vial (the lowest wholesale cost to the hospital), four times the cost in Europe.2,3 In addition, according to data from the Multi-center AIDS. © 1991, Massachusetts Medical Society. All rights reserved.
Compliance Committees and Recent Multilateral Environmental Agreements: The Canadian Experience with Their Negotiation and Operation
In order to enhance and encourage compliance with obligations in multilateral environmental agreements (MEAs), states have agreed to the creation of compliance committees for all of the recent MEAs. Canada has been a strong supporter of the compliance committee experiment and an active participant in the negotiation and operation of numerous MEA compliance committees. This article does three things. First, it examines the international legal nature of the MEA compliance committees. Second, the key issues of the structure of the committees are explored. Finally, the article look at the development and operation of compliance committees pursuant to: the Montreal Protocol; the LRTAP Convention; the Espoo Convention; the Basel Convention; the Cartagena Protocol; the Rotterdam Convention; the Stockholm Convention; and the Protocol to the London Dumping Convention.
Online cognitive monitoring technology for people with Parkinson's disease and REM sleep behavioural disorder.
Automated online cognitive assessments are set to revolutionise clinical research and healthcare. However, their applicability for Parkinson's Disease (PD) and REM Sleep Behavioural Disorder (RBD), a strong PD precursor, is underexplored. Here, we developed an online battery to measure early cognitive changes in PD and RBD. Evaluating 19 candidate tasks showed significant global accuracy deficits in PD (0.65 SD, p = 0.003) and RBD (0.45 SD, p = 0.027), driven by memory, language, attention and executive underperformance, and global reaction time deficits in PD (0.61 SD, p = 0.001). We identified a brief 20-min battery that had sensitivity to deficits across these cognitive domains while being robust to the device used. This battery was more sensitive to early-stage and prodromal deficits than the supervised neuropsychological scales. It also diverged from those scales, capturing additional cognitive factors sensitive to PD and RBD. This technology offers an economical and scalable method for assessing these populations that can complement standard supervised practices.
LGI1-antibody encephalitis: how to approach this highly treatable dementia mimic in memory and mental health services.
Leucine-rich glioma-inactivated 1-antibody-encephalitis is a treatable and potentially reversible cause of cognitive and psychiatric presentations, and may mimic cognitive decline, rapidly progressive dementia and complex psychosis in older patients. This aetiology is of immediate relevance given the alternative treatment pathway required, compared with other conditions presenting with cognitive deficits.
Give it a second try? The influence of feedback and performance in the decision of reattempting.
Feedback evaluation can affect behavioural continuation or discontinuation, and is essential for cognitive and motor skill learning. One critical factor that influences feedback evaluation is participants' internal estimation of self-performance. Previous research has shown that two event-related potential components, the Feedback-Related Negativity (FRN) and the P3, are related to feedback evaluation. In the present study, we used a time estimation task and EEG recordings to test the influence of feedback and performance on participants' decisions, and the sensitivity of the FRN and P3 components to those factors. In the experiment, participants were asked to reproduce the total duration of an intermittently presented visual stimulus. Feedback was given after every response, and participants had then to decide whether to retry the same trial and try to earn reward points, or to move on to the next trial. Results showed that both performance and feedback influenced participants' decision on whether to retry the ongoing trial. In line with previous studies, the FRN showed larger amplitude in response to negative than to positive feedback. Moreover, our results were also in agreement with previous works showing the relationship between the amplitude of the FRN and the size of feedback-related prediction error (PE), and provide further insight in how PE size influences participants' decisions on whether or not to retry a task. Specifically, we found that the larger the FRN, the more likely participants were to base their decision on their performance - choosing to retry the current trial after good performance or to move on to the next trial after poor performance, regardless of the feedback received. Conversely, the smaller the FRN, the more likely participants were to base their decision on the feedback received.