Skill enactment and knowledge acquisition among community users of digital mental health interventions: qualitative study with thematic analysis.

BACKGROUND: The acquisition of knowledge and use of skills from digital mental health interventions (DMHIs) are considered important for effectiveness. However, our understanding of user experiences implementing skills learned from these interventions is limited, particularly outside of research trials. This qualitative study aimed to investigate how community users learn and apply knowledge and skills from DMHIs based on cognitive behavioural therapy (CBT) in daily life. The study also examined factors influencing the selection and use of skills and explored perceived changes in mental health resulting from the intervention. METHODS: Thirteen adults aged 26 to 66 years (10 females) were recruited using social media advertising and participated in semi-structured interviews by telephone or videoconference. All participants were living in Australia and had used a digital CBT program within the past 3 months. Interviews lasted on average 45 min. Transcripts were analysed using theoretical thematic analysis. RESULTS: Participants demonstrated high levels of program engagement. Findings were organised into three topics with six major themes. Participants reported that their chosen intervention reinforced existing knowledge and fostered new skills and insights (Topic 1, Theme 1: knowledge consolidation). Most described actively applying skills (Topic 1, Theme 2: active approach to skill enactment), although the extent of learning and range of skills enacted varied across participants. Influences on skill selection included the perceived relevance of intervention strategies to the user's needs and personal characteristics (Topic 2, Theme 1: relevance of intervention strategies), as well as the perceived or experienced effectiveness of those strategies (Topic 2, Theme 2: perceived and experienced benefit). Challenges to ongoing skill enactment included time scarcity, prioritisation difficulties, and lack of motivation (Topic 2, Theme 3: navigating time constraints and low motivation). Improvements in mental health were generally modest and attributed mainly to participants' proactive efforts (Topic 3, Theme 1: perceived changes). CONCLUSIONS: DMHIs may reinforce existing understanding of psychotherapeutic strategies, offer new knowledge, and encourage the application of skills in everyday life among community users who actively engage with these interventions. Future research should prioritise personalising DMHIs and investigating methods to optimise the acquisition, retention, and sustained application of knowledge and skills.

Polysomnographic features prior to dream enactment behaviors in isolated rapid eye movement sleep behavior disorder.

OBJECTIVE: This study aimed to identify electroencephalogram correlates of dream enactment behaviors (DEBs) and elucidate their cortical dynamics in patients with isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD). METHODS: This cross-sectional study included 15 patients with iRBD. Two REM sleep periods in routine polysomnography were compared: the 60 s preceding the DEBs ("pre-representative behavior" [preR]), and the 60 s with the least submental electromyogram activity ("background" [BG]). Six EEG frequency bands and electrooculogram were analyzed; power spectra, coherence and phase-locking values in four 15-s periods were examined to assess trends. These indices were also compared between preR and BG. RESULTS: Compared with BG, significantly higher delta power in the F3 channel and gamma power in the F4 and O2 channels were observed during preR. For functional connectivity, the widespread beta-band connectivity was significantly increased during preR than BG. CONCLUSION: Before notable REM sleep behaviors, uneven distributed higher EEG spectral power in both very low and high frequencies, and increased wide-range beta band functional connectivity, were observed over 60 s, suggesting cortical correlates to subsequent DEBs. SIGNIFICANCE: This study may shed light on the pathological mechanisms underlies RBD through the routine vPSG analysis, leading to detection of DEBs.

Skill Enactment Among University Students Using a Brief Video-Based Mental Health Intervention: Mixed Methods Study Within a Randomized Controlled Trial.

BACKGROUND: Mental health problems are common among university students, yet many students do not seek professional help. Digital mental health interventions can increase students' access to support and have been shown to be effective in preventing and treating mental health problems. However, little is known about the extent to which students implement therapeutic skills from these programs in everyday life (ie, skill enactment) or about the impact of skill enactment on outcomes. OBJECTIVE: This study aims to assess the effects of a low-intensity video-based intervention, Uni Virtual Clinic Lite (UVC-Lite), in improving skill enactment relative to an attention-control program (primary aim) and examine whether skill enactment influences symptoms of depression and anxiety (secondary aim). The study also qualitatively explored participants' experiences of, and motivations for, engaging with the therapeutic techniques. METHODS: We analyzed data from a randomized controlled trial testing the effectiveness of UVC-Lite for symptoms of depression and anxiety among university students with mild to moderate levels of psychological distress. Participants were recruited from universities across Australia and randomly assigned to 6 weeks of self-guided use of UVC-Lite (243/487, 49.9%) or an attention-control program (244/487, 50.1%). Quantitative data on skill enactment, depression, and anxiety were collected through baseline, postintervention, and 3- and 6-month follow-up surveys. Qualitative data were obtained from 29 intervention-group participants through open-ended questions during postintervention surveys (n=17, 59%) and semistructured interviews (n=12, 41%) after the intervention period concluded. RESULTS: Mixed model repeated measures ANOVA demonstrated that the intervention did not significantly improve skill enactment (F3,215.36=0.50; P=.68). Skill enactment was also not found to influence change in symptoms of depression (F3,241.10=1.69; P=.17) or anxiety (F3,233.71=1.11; P=.35). However, higher levels of skill enactment were associated with lower symptom levels among both intervention and control group participants across time points (depression: F1,541.87=134.61; P<.001; anxiety: F1,535.11=73.08; P<.001). Inductive content analysis confirmed low levels of skill enactment among intervention group participants. Participants were motivated to use techniques and skills that were perceived to be personally relevant, easily integrated into daily life, and that were novel or had worked for them in the past. CONCLUSIONS: The intervention did not improve skill enactment or mental health among students with mild to moderate psychological distress. Low adherence impacted our ability to draw robust conclusions regarding the intervention's impact on outcomes. Factors influencing skill enactment differed across individuals, suggesting that it may be necessary to tailor therapeutic skills and engagement strategies to the individual user. Theoretically informed research involving collaboration with end users is needed to understand the processes underlying skill enactment in digital mental health interventions. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://tinyurl.com/7b9ar54r.

Identity enactment as a social accomplishment: Shared identity and the provision of mutual support amongst pilgrims undertaking the Hajj.

Experimental and survey research shows that a common group membership can result in increased levels of social support. Here we complement such research with qualitative data concerning the forms and function of such support. Specifically, we explore the mutual support reported by pilgrims undertaking the Hajj. This requires participants enact a series of identity-related beliefs and values (including specific rituals) in conditions that are practically and psychologically challenging. Using data obtained through semi-structured interviews (N = 33), we investigate how participants' shared identity facilitated their behavioural enactment of these identity-defining beliefs and values. We focus on how their shared understanding of their beliefs and values as Hajj pilgrims allowed various forms of support (psychological, material, informational, and behavioural) which helped participants translate their identity-related ideals into behaviour. Our analysis implies that a shared identity provides a frame of reference with which group members can recognize each other's identity-related concerns and what they need in order to enact their identity. In turn, it implies that in situations where there are practical and psychological constraints on behaviour, action in terms of one's social identity can be conceptualized as a joint accomplishment in which the mutual support of group members is key.

A behavioral and eye movement study on inhibitory processing of action memory.

Recent evidence highlights the critical role of effective interference inhibition for optimal memory performance, yet its function in action memory remains relatively underexplored. The current study investigated inhibitory processes in action memory during encoding and storage stages. In Experiment 1, 100 participants were divided into high and low cognitive inhibition groups using the Stroop color naming task. They performed either a subject-performed task (SPT) or a verbal task (VT) under varying semantic interference levels to assess the interaction between individual inhibitory abilities and the inhibition processing of action memory during encoding. Results indicated no significant difference in inhibition effects (IF) between high and low inhibition groups in SPT under high semantic interference, while in VT, those with high cognitive inhibition demonstrated significantly greater IF than those with low. Experiment 2, involving 57 participants, employed a point detection task and eye-tracking to explore attentional inhibition mechanisms during action memory storage. Behavioral results showed greater IF for SPT than VT under semantic interference. Eye-tracking revealed higher initial fixation rates and shorter durations for SPT subjects during the early processing stage, and significantly fewer and shorter fixations in the later stage compared to VT subjects. These findings imply stronger inhibitory processing in SPT during both encoding and storage stages under semantic interference, with attentional inhibition of action memories occurring predominantly in the later stage.

Use of Countertransference to Advance Therapeutic Efficacy.

Countertransference is a basic tenet of psychodynamic theory. Although it was initially considered an unwelcome phenomenon in psychiatry, attitudes have shifted, and many mental health professionals now consider it to be a useful therapeutic tool. In this article, the author discusses countertransference as defined by the International Psychoanalytical Association's Inter-Regional Encyclopedic Dictionary of Psychoanalysis (IRED) and examines its clinical impact by using constructed vignettes of psychodynamic psychotherapies to illustrate theoretical points. As IRED delineates, countertransferences may exist at the conscious or unconscious level. In addition, the author suggests that countertransference may also exist at the preconscious level. Clinicians' examination of all levels of countertransference has the potential to be revelatory and facilitate therapeutic action, whereas unexamined countertransference can interfere with effective treatment. For this reason, self-reflection on the part of psychiatrists is essential.

Enactment encoding promotes relative temporal order memory.

Studies have shown that enactment improves memory; however, in daily life, our memories of motor events often exhibit a relative temporal order. Therefore, this study examined whether enactment promotes relative temporal order memory. In Experiment 1, a sequential recall task and a subject-performed task were used to explore whether enactment encoding improved relative temporal order memory. The results showed that the relative temporal order memory of the enactment-encoding group was significantly better than that of the verbal-encoding group, indicating that enactment promoted relative temporal order memory. Since temporal order memory is often affected by spatial cues, in Experiment 2, we further controlled spatial cues and used a 2 (spatial cues: consistent with temporal order, vs. no cues) × 2 (encoding type: verbal vs. enactment) design to explore whether spatial cues influence the effect of enactment encoding on temporal order memory. The results showed that compared with verbal encoding, enactment encoding significantly improved relative temporal order memory. However, no effect of spatial cues on relative temporal order memory was found. Our study confirmed that enactment encoding promotes relative temporal order memory performance independent of spatial cues.

Fast and friendly: The role of vocal cues in adolescents' responses to and perceptions of peer provocation.

Adolescents self-report using different strategies to respond to peer provocation. However, we have a limited understanding of how these responses are behaviorally enacted and perceived by peers. This study examined the extent to which adolescents' self-reported responses to peer provocation (i.e., aggressive, assertive, and withdrawn) predicted how their vocal enactments of standardized responses to peer provocation were perceived by other adolescents. Three vocal cues relevant to the communication of emotional intent-average pitch, average intensity, and speech rate-were explored as moderators of these associations. Adolescent speakers (n = 39; Mage = 12.67; 66.7% girls) completed a self-report measure of how they would choose to respond to scenarios involving peer provocation; they also enacted standardized vocal responses to hypothetical peer provocation scenarios. Recordings of speakers' vocal responses were presented to a separate sample of adolescent listeners (n = 129; Mage = 12.12; 52.7% girls) in an online listening task. Speakers who self-reported greater use of assertive response strategies enacted standardized vocal responses that were rated as significantly friendlier by listeners. Vocal responses enacted with faster speech rates were also rated as significantly friendlier by listeners. Speakers' self-reported use of aggression and withdrawal was not significantly related to listeners' ratings of their standardized vocal responses. These findings suggest that adolescents may be perceived differently by their peers depending on the way in which their response is enacted; specifically, faster speech rate may be perceived as friendlier and thus de-escalate peer conflict. Future studies should consider not only what youth say and/or do when responding to peer provocation but also how they say it.

Practice is the best of all instructors-Effects of enactment encoding and episodic future thinking on prospective memory performance in high-functioning adults with autism spectrum disorder.

Prospective memory (PM) is the ability to remember to carry out intended actions in the future. The present study investigated the effects of episodic future thinking (EFT) and enactment encoding (EE) on PM performance in autistic adults (ASD). A total of 72 autistic individuals and 70 controls matched for age, gender, and cognitive abilities completed a computerized version of the Dresden breakfast Task, which required participants to prepare breakfast following a set of rules and time restrictions. A two (group: ASD vs. controls) by three (encoding condition: EFT vs. EE vs. standard) between-subjects design was applied. Participants were either instructed to engage in EFT or EE to prepare to the different tasks prior to performing the Dresden breakfast or received standard instructions. Analyses of variance were conducted. Autism-spectrum-disorders (ASD) participants did not differ from control participants in their PM performance, regardless of which strategy they used. Compared to the standard condition, EE but not EFT improved time-based PM performance in all participants. This is the first study to find spared time-based PM performance in autistic individuals. The results confirm earlier results of beneficial effects of EE on PM performance. Findings are discussed with regards to the methodology used, sample composition as well as autistic characteristics.

The self-reference effect in attention deficit hyperactivity disorder.

The self-memory system depends on the prioritization and capture of self-relevant information, so may be disrupted by difficulties in attending to, encoding and retrieving self-relevant information. The current study compares memory for self-referenced and other-referenced items in children with ADHD and typically developing comparison groups matched for verbal and chronological age. Children aged 5-14 (N = 90) were presented with everyday objects alongside an own-face image (self-reference trials) or an unknown child's image (other-referenced trials). They were asked whether the child shown would like the object, before completing a surprise source memory test. In a second task, children performed, and watched another person perform, a series of actions before their memory for the actions was tested. A significant self-reference effect (SRE) was found in the typically developing children (i.e. both verbal and chronological age-matched comparison groups) for the first task, with significantly better memory for self-referenced than other-referenced objects. However, children with ADHD showed no SRE, suggesting a compromised ability to bind information with the cognitive self-concept. In the second task, all groups showed superior memory for actions carried out by the self, suggesting a preserved enactment effect in ADHD. Implications and applications for the self-memory system in ADHD are discussed.

On the Belatedness of Psychoanalytic Clinical Writing.

The belatedness of analytic writing and its effects on analytic processes are explored through the concepts of nachträglichkeit and thirdness. The temporal gap between being with and writing about functions as a meaningful pause filled with opportunities for investigating unconscious pathways to the analyst's countertransference. The significance of analytic narration in affecting specific psychoanalytic developments is explored. The theoretical framework utilizes the concept of après coup, which brings to light new meanings in an afterwardness of time. Aspects of analytical writing dynamics are discussed as equivalent to those of nachträglichkeit. Analysts also deploy thirdness in constructing presentations of clinical material. This could be an intrapsychic third or an external figure representing an internal introjected third. A clinical vignette demonstrates the enhanced understanding achieved by writing. It specifically assisted in exploring the analyst's enactment relating to change in the setting, the background for which was a move to online analysis. This evoked infantile anxieties and painful confusions about loss. Historically, the patient had to navigate a path through miasmic ambiguities between reality and phantasy, truths and lies. A conclusion is reached, arguing that analytic processes extend beyond the duration of sessions, and that the processes of clinical writing can provide a significant contribution.

Redundancy effect of initial enactment encoding and subsequent testing on memory enhancement: Insights from an electrophysiological study.

Testing is more beneficial for memory retention than restudying the same content. However, the effect of the initial encoding method on the testing effect remains unclear. In this study, a classical testing effect paradigm was employed, along with event-related potentials (ERP), to investigate the electrophysiological processes underlying the effect of enactment encoding on the testing effect. Participants were randomly assigned to the Self-Performed Test (SPT) or Verbalized Test (VT) groups. Both groups underwent three stages: an initial encoding phase, an initial test phase (comprising a source memory task and a restudy task), and a final test phase. During the initial encoding phase, the SPT group encoded action phrases through enactment, while the VT group encoded information through reading. During the initial test phase, the SPT group exhibited superior recognition performance in item memory compared with the VT group. Both groups exhibited significant parietal old/new effects in the source memory task, with only the SPT group displaying parietal positivity during the restudy task. During the final test phase, the behavioral testing effect was exclusively observed in the VT group. Furthermore, the VT group displayed a more pronounced parietal positivity in the test condition compared to the restudy condition, while the parietal positivity between the two conditions was comparable in the SPT group. In summary, the absence of a final behavioral testing effect in the SPT group may be attributed to both enactment and testing primarily enhancing memory performance through recollection-based retrieval, as indicated by the parietal positivity. Consequently, the initial enactment encoding method leaves limited scope for further improvements through subsequent testing. These findings suggest that initial enactment encoding, and subsequent testing may be redundant in improving episodic memory performance.

Mocking enactments: a case study of multimodal stance-stacking.

Although research into multimodal stance-taking has gained momentum over the past years, the multimodal construction of so-called stacked stances has not yet received systematic attention in the literature. Mocking enactments are a prime example of such complex social actions as they are layered both interactionally and stance-related, and they rely significantly on the use of bodily visual resources, depicting rather than describing events and stances. Using Du Bois' Stance Triangle as a framework, this study investigates mocking enactments as a case study to unravel the multimodal aspects of layered stance expressions. Drawing on three data sets-music instruction in Dutch, German, and English, spontaneous face-to-face interactions among friends in Dutch, and narrations on past events in Flemish Sign Language (VGT)-this study provides a qualitative exploration of mocking enactments across different communicative settings, languages, and modalities. The study achieves three main objectives: (1) illuminating how enactments are used for mocking, (2) identifying the layers of stance-taking at play, and (3) examining the multimodal construction of mocking enactments. Our analysis reveals various different uses of enactments for mocking. Aside from enacting the target of the mockery, participants can include other characters and viewpoints, highlighting the breadth of the phenomenon under scrutiny. Second, we uncover the layered construction of stance on all axes of the Stance Triangle (evaluation, positioning, and alignment). Third, we find that mocking enactments are embedded in highly evaluative contexts, indexed by the use of bodily visual resources. Interestingly, not all mocking enactments include a multimodally exaggerated depiction, but instead, some merely allude to an absurd hypothetical scenario. Our findings contribute to the growing body of literature on multimodal stance-taking, by showing how a nuanced interpretation of the Stance Triangle can offer a useful framework for analyzing layered stance acts.

A RCT to explore the effectiveness of supporting adherence to nebuliser medication in adults with cystic fibrosis: fidelity assessment of study interventions.

BACKGROUND: A multi-component self-management intervention 'CFHealthHub' was developed to reduce pulmonary exacerbations in adults with Cystic Fibrosis (CF) by supporting adherence to nebuliser medication. It was evaluated in a randomized controlled trial (RCT) involving 19 CF centres, with 32 interventionists, 305 participants in the intervention group, and 303 participants in the standard care arm. Ensuring treatment fidelity of intervention delivery was crucial to ensure that the intervention produced the expected outcomes. METHODS: Fidelity of the CFHealthHub intervention and standard care was assessed using different methods for each of the five fidelity domains defined by the Borrelli framework: study design, training, treatment delivery, receipt, and enactment. Study design ensured that the groups received the intended intervention or standard care. Interventionists underwent training and competency assessments to be deemed certified to deliver the intervention. Audio-recorded intervention sessions were assessed for fidelity drift. Receipt was assessed by identifying whether participants set Action and Coping Plans, while enactment was assessed using click analytics on the CFHealthHub digital platform. RESULTS: Design: There was reasonable agreement (74%, 226/305) between the expected versus actual intervention dose received by participants in the CFHealthHub intervention group. The standard care group did not include focused adherence support for most centres and participants. Training: All interventionists were trained. Treatment delivery: The trial demonstrated good fidelity (overall fidelity by centre ranged from 79 to 97%), with only one centre falling below the mean threshold (> 80%) on fidelity drift assessments. Receipt: Among participants who completed the 12-month intervention, 77% (205/265) completed at least one action plan, and 60% (160/265) completed at least one coping plan. Enactment: 88% (268/305) of participants used web/app click analytics outside the intervention sessions. The mean (SD) number of web/app click analytics per participant was 31.2 (58.9). Additionally, 64% (195/305) of participants agreed to receive notifications via the mobile application, with an average of 53.6 (14.9) notifications per participant. CONCLUSIONS: The study demonstrates high fidelity throughout the RCT, and the CFHealthHub intervention was delivered as intended. This provides confidence that the results of the RCT are a valid reflection of the effectiveness of the CFHealthHub intervention compared to standard care. TRIAL REGISTRATION: ISRCTN registry: ISRCTN55504164 (date of registration: 12/10/2017).

Characterising the declarative-procedural transformation in instruction-based learning.

Many accounts of instruction-based learning assume that initial declarative representations are transformed into executable procedural ones, so as to enable instruction implementation. We tested the hypothesis that declarative-procedural transformation should be bound to a specific response modality and not transferable across different modalities. In Experiment 1, novel stimulus-response instructions had to be implemented either verbally or manually either once or three times. Modality-specific procedural encoding was probed via a subsequent implicit priming test. This involved the same stimuli but required a response that could be either compatible or incompatible with the originally instructed response using either the same or a different response modality. We found that procedural encoding was modality-specific as indicated by a stronger repetition-dependent increase of the compatibility effect when response modality was unchanged. Explicit test performance, serving as a marker of declarative encoding, was independent of modality transition and it was uncorrelated with implicit test performance. Unexpectedly, the implicit priming test also revealed a small yet significant transfer to the response modality that was previously not overtly implemented, likely reflecting covert response "simulation". To examine if covertly simulated responding occurs even when instruction implementation is omitted altogether, we conducted Experiment 2. Subjects merely viewed novel stimulus-response instructions prior to testing. Again, we found evidence for procedural encoding of the non-implemented instructions. Moreover, a direct comparison of both experiments revealed higher test scores (both implicit and explicit) for previously non-implemented instructions than for previously implemented instructions. This calls for theoretical reconciliation with diverging previous study results.

Educational Resources to Support Patients with Parasomnias.

This article serves to help reduce patient burden in searching for credible information about parasomnias-abnormal behaviors during sleep-including sleepwalking, night terrors, and rapid eye movement sleep behavior disorder. It exhibits a compiled list of accessible online resources about parasomnias as well as detailed descriptions about each resource. By increasing patient accessibility to clinically validated resources, patients are more empowered to take an active role in managing their conditions, collaborating with their health-care practitioners in clinical management, enrolling in registries, and joining newsletters sponsored by these resources.

A case of prazosin in treatment of rapid eye movement sleep behavior disorder.

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream-enactment behaviors that emerge during a loss of REM sleep atonia. Untreated RBD carries risks for physical injury from falls or other traumatic events during dream enactment as well as risk of injury to the bed partner. Currently, melatonin and clonazepam are the mainstay pharmacological therapies for RBD. However, therapeutic response to these medications is variable. While older adults are most vulnerable to RBD, they are also particularly vulnerable to the adverse effects of benzodiazepines, including increased risk of falls, cognitive impairment, and increased risk of Alzheimer disease. Prazosin is a centrally active alpha-1 adrenergic receptor antagonist often prescribed for trauma nightmares characterized by REM sleep without atonia in patients with posttraumatic stress disorder. We report a case of successful RBD management with prazosin in a patient in whom high-dose melatonin was ineffective. Although there was no observable reduction in dream-enactment behaviors with high-dose melatonin, the possibility of a synergistic effect of prazosin combined with melatonin cannot be ruled out. This case report supports further evaluation of prazosin as a potential therapeutic for RBD. CITATION: Cho Y, Iliff JJ, Lim MM, Raskind M, Peskind E. A case of prazosin in treatment of rapid eye movement sleep behavior disorder. J Clin Sleep Med. 2024;20(2):319-321.

Development of fidelity of delivery and enactment measures for interventions in communication disorders.

OBJECTIVES: This study was part of a process evaluation for a single-blind, randomized controlled pilot study comparing Better Conversations with Primary Progressive Aphasia (BCPPA), an approach to communication partner training, with no speech and language therapy treatment. It was necessary to explore fidelity of delivery (delivery of intervention components) and intervention enactment (participants' use of intervention skills in the form of conversation behaviours comprising facilitators, that enhance the conversational flow, and barriers, that impeded the flow of conversation). This study aimed to: (1) Outline an adapted methodological process that uses video observation, to measure both fidelity of delivery and enactment. (2) Measure the extent to which the BCPPA pilot study was delivered as planned, and enacted. DESIGN: Observational methods were used alongside statistical analysis to explore the fidelity of intervention and enactment using video recordings obtained from the BCPPA pilot study. METHODS: A 5-step methodology, was developed to measure fidelity of delivery and enactment for the BCPPA study using video-recorded data. To identify delivery of intervention components, a random sample of eight video recorded and transcribed BCPPA intervention sessions was coded. To examine the enactment of conversation behaviours, 108 transcribed 10 -min-video recorded conversations were coded from 18 participants across the control and intervention group. RESULTS: Checklists and guidelines for measurement of fidelity of treatment delivery and coding spreadsheets and guidelines for measurement of enactment are presented. Local collaborators demonstrated 87.2% fidelity to the BCPPA protocol. Participants in the BCPPA treatment group increased their use of facilitator behaviours enacted in conversation from a mean of 13.5 pre-intervention to 14.2 post-intervention, whilst control group facilitators decreased from a mean of 15.5 to 14.4, over the same timescale. CONCLUSIONS: This study proposes a novel and robust methods, using video recorded intervention sessions and conversation samples, to measure both fidelity of intervention delivery and enactment. The learnings from this intervention are transferable to other communication interventions.

Exploring techniques for encoding spoken instructions in working memory: a comparison of verbal rehearsal, motor imagery, self-enactment and action observation.

Encoding and recalling spoken instructions is subject to working memory capacity limits. Previous research suggests action-based encoding facilitates instruction recall, but has not directly compared benefits across different types of action-based techniques. The current study addressed this in two experiments with young adults. In Experiment 1, participants listened to instructional sequences containing four action-object pairs, and encoded these instructions using either a motor imagery or verbal rehearsal technique, followed by recall via oral repetition or enactment. Memory for instructions was better when participants used a motor imagery technique during encoding, and when recalling the instructions by enactment. The advantage of using a motor imagery technique was present in both verbal and enacted recall. In Experiment 2, participants encoded spoken instructions whilst implementing one of four techniques (verbal rehearsal, motor imagery, observation of others' actions or self-enactment), and then recalled the instructions by oral repetition or enactment. For both verbal and enacted recall, memory for instructions was least accurate in the rehearsal condition, while the other encoding conditions did not differ from each other. These novel findings indicate similar benefits of imagining, observation and execution of actions in encoding spoken instructions, and enrich current understanding of action-based benefits in working memory.