Features of Self-Organization during the Process of Mindfulness-Based Stress Reduction: A Single Case Study.

Compared to the extensive evidence of the effectiveness of mindfulness-based interventions, there is only a limited understanding of their mechanisms of change. The three aims of this study are (1) to identify features of self-organization during the process (e.g., pattern transitions), (2) to obtain an impression of the effects of continuous self-assessments and feedback sessions on mindfulness-related stress reduction, and (3) to test the feasibility of high-frequency process monitoring and process feedback. Concerning aim (1), the specific hypothesis is that change will occur as a cascade of discontinuous pattern transitions emerging spontaneously in the sense of not being a reaction to external input. This single case study describes changing patterns of multiple time series that were produced by app-based daily self-assessments during and after an 8-week mindfulness-based stress reduction program. After this MBSR program, the participant (a female nurse) continued the self-assessment and the mindfulness practice for a further 10 months. The results confirm findings on the positive effects of mindfulness programs for healthcare professionals, especially on coping with work-related stress. The analysis of the time series data supports the hypothesis of self-organization as a possible mechanism of change manifesting as a cascade of phase transitions in the dynamics of a biopsychosocial system. At the end of the year, the participant reported a beneficial impact of daily monitoring and systematic feedback on the change process. The results underline the feasibility and usefulness of continuous high-frequency monitoring during and after mindfulness interventions.

Extending the use of routine outcome monitoring: Predicting long-term outcomes in cognitive behavioral therapy for severe health anxiety.

Objective: Routine outcome monitoring (ROM) is a well-evidenced means of improving psychotherapy's effectiveness. However, it is unclear how meaningful ROM is for problems that span physical and mental health, such as severe health anxiety. Physical and mental health comorbidities are common amongst severe health anxiety sufferers and cognitive behavioral therapy (CBT) is a recommended treatment. Method: Seventy-nine participants received CBT for severe health anxiety in a clinical trial. The Outcome Rating Scale (ORS: a ROM assessment of wellbeing) was completed at each session. Multilevel modeling assessed whether last-session ORS predicted health anxiety and other outcomes over 12-month follow-up. Similar models were developed using health anxiety as a comparative outcome-predictor. Outcome-improvements of treatment-responders with sudden gains were compared to those of non-sudden-gainers. Results: Last-session ORS scores predicted all outcomes up to 12 months later, with a comparable predictive effect to health anxiety. Sudden-gainers on the ORS reported significantly greater improvement in depression, functioning, and wellbeing, but no difference in health anxiety or other measures. Conclusion: The ORS may be a feasible, overall estimate of health, functioning, and quality of life in psychotherapy for severe health anxiety. Sudden gains on the ORS may be clinically meaningful with respect to some long-term outcomes.

Self-affirmation enhances the processing of uncertainty: An event-related potential study.

We proposed that self-affirmation can endow people with more cognitive resource to cope with uncertainty. We tested this possibility with an event-related potential (ERP) study by examining how self-affirmation influences ambiguous feedback processing in a simple gambling task, which was used to investigate risk decision-making. We assigned 48 participants randomly to the affirmation and non-affirmation (i.e., control) groups. All participants accepted the manipulation first and then completed the gambling task with an electroencephalogram (EEG) recording, in which participants might receive a positive (winning), negative (losing), or ambiguous (unknown valence) outcome after they made a choice. We considered both the feedback-related negativity (FRN) and P3 components elicited by the outcome feedback, which reflected the amount of cognitive resources being invested in the early and late stages of the outcome feedback processing, respectively. ERP results showed that ambiguous feedback elicited a larger FRN among affirmed participants than unaffirmed participants but exerted no influence on the P3. This finding suggests that self-affirmation may help coping with uncertainty by enhancing the early processing of uncertainty.

Assessing Technology in the Absence of Proof: Trust Based on the Interplay of Others' Opinions and the Interaction Process.

OBJECTIVE: The present research addresses the question of how trust in systems is formed when unequivocal information about system accuracy and reliability is absent, and focuses on the interaction of indirect information (others' evaluations) and direct (experiential) information stemming from the interaction process. BACKGROUND: Trust in decision-supporting technology, such as route planners, is important for satisfactory user interactions. Little is known, however, about trust formation in the absence of outcome feedback, that is, when users have not yet had opportunity to verify actual outcomes. METHOD: Three experiments manipulated others' evaluations ("endorsement cues") and various forms of experience-based information ("process feedback") in interactions with a route planner and measured resulting trust using rating scales and credits staked on the outcome. Subsequently, an overall analysis was conducted. RESULTS: Study 1 showed that effectiveness of endorsement cues on trust is moderated by mere process feedback. In Study 2, consistent (i.e., nonrandom) process feedback overruled the effect of endorsement cues on trust, whereas inconsistent process feedback did not. Study 3 showed that although the effects of consistent and inconsistent process feedback largely remained regardless of face validity, high face validity in process feedback caused higher trust than those with low face validity. An overall analysis confirmed these findings. CONCLUSION: Experiential information impacts trust even if outcome feedback is not available, and, moreover, overrules indirect trust cues-depending on the nature of the former. APPLICATION: Designing systems so that they allow novice users to make inferences about their inner workings may foster initial trust.

Decision- and feedback-related brain potentials reveal risk processing mechanisms in patients with alcohol use disorder.

Individuals with alcohol use disorder (AUD) are aware of the risks of alcohol abuse yet continue risky drinking. Research indicates that dysfunctional decision processes and trait variables such as impulsivity contribute to this awareness-behavior discrepancy. The present study focused on decision-related versus feedback-related processes as potential contributors to decision making in AUD by examining the relationship between decision choices and decision- and feedback-related ERP phenomena in the balloon analogue risk task (BART). N = 39 AUD and n = 35 healthy comparison participants (HC) performed the BART modified for EEG assessment. In each of 100 runs, participants made a series of choices about whether to pump up a virtual balloon, which popped pseudorandomly, ending the run. Alternatively, participants ended the run by pressing a "cash-out" button. Each pump not producing a pop provided .05 €; popping resulted in loss of the run's accumulated gain. Groups made similar choices, though AUD responded more slowly. The decision P3 200-400 ms after decision prompt (balloon) was larger in AUD than in HC, and decision P3 enhancement on high-risk trials predicted choices to pump. Feedback-related negativity (FRN) after loss (relative to cash out) feedback was smaller in AUD than in HC, suggesting indifference to negative feedback. In AUD, high impulsivity was associated with risk-modulated decision P3 but not FRN. Results indicate atypical decision- and feedback-related processes that could contribute to difficulties in engaging with daily challenges effectively.

The use of outcome feedback by emergency medicine physicians: Results of a physician survey.

BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of emergency department (ED) outcome feedback called the return visit report (RVR) and present the results of a survey assessing physicians' perceptions of this novel form of feedback. METHODS: An Opinio web-based survey was conducted in 81 emergency physicians (EPs) at three EDs. RESULTS: Of the 81 physicians surveyed, 40 (49%) responded. Most participants indicated that they frequently review their RVRs (83%), that RVRs are valuable to their practice of medicine (80%), and that RVRs alter their practice in future encounters (57%). Respondents reported seeking other forms of outcome feedback including speaking with other EPs (83%) and reviewing discharge summaries of admitted patients (87%). There was no correlation between demographic data and use of RVRs. CONCLUSION: EPs value RVRs as a form of feedback. RVRs could be improved by reducing the observational interval and optimizing report relevance and differential weighting.

Improving the efficiency of psychological treatment using outcome feedback technology.

AIMS: This study evaluated the impact of applying computerized outcome feedback (OF) technology in a stepped care psychological service offering low and high intensity therapies for depression and anxiety. METHODS: A group of therapists were trained to use OF based on routine outcome monitoring using depression (PHQ-9) and anxiety (GAD-7) measures. Therapists regularly reviewed expected treatment response graphs with patients and discussed cases that were "not on track" in clinical supervision. Clinical outcomes data were collected for all patients treated by this group (N = 594), six months before (controls = 349) and six months after the OF training (OF cases = 245). Symptom reductions in PHQ-9 and GAD-7 were compared between controls and OF cases using longitudinal multilevel modelling. Treatment duration and costs were compared using MANOVA. Qualitative interviews with therapists (N = 15) and patients (N = 6) were interpreted using thematic analysis. RESULTS: OF technology was generally acceptable and feasible to integrate in routine practice. No significant between-group differences were found in post-treatment PHQ-9 or GAD-7 measures. However, OF cases had significantly lower average duration and cost of treatment compared to controls. CONCLUSIONS: After adopting OF into their practice, this group of therapists attained similar clinical outcomes but within a shorter space of time and at a reduced average cost per treatment episode. We conclude that OF can improve the efficiency of stepped care.

Outcome Feedback within Emergency Medicine Training Programs: An Opportunity to Apply the Theory of Deliberate Practice?

OBJECTIVES: Outcome feedback is the process of learning patient outcomes after their care within the emergency department. We conducted a national survey of Canadian Royal College emergency medicine (EM) residents and program directors to determine the extent to which active outcome feedback and follow-up occurred. We also compared the perceived educational value of outcome feedback between residents and program directors. METHODS: We distributed surveys to all Royal College-accredited adult and pediatric EM training programs using a modified Dillman method. We analyzed the data using student's t-test for continuous variables and Fisher's exact test for categorical variables. RESULTS: We received 210 completed surveys from 260 eligible residents (80.8%) and 21 of 24 program directors (87.5%) (overall 81.3%). Mandatory active outcome feedback was not present in any EM training program for admitted or discharged patients (0/21). Follow-up was performed electively by 89.4% of residents for patients admitted to the hospital, and by 44.2% of residents for patients discharged home. A majority of residents (76.9%) believed that patient follow-up should be mandatory compared to 42.9% of program directors (p=0.002). The perceived educational value of outcome feedback was 5.8/7 for residents and 5.1/7 for program directors (difference 0.7; p=0.002) based on a seven-point Likert scale (1=not important; 7=very important). CONCLUSION: While Canadian EM training programs do not mandate follow-up, it is performed electively by the majority of residents surveyed. Residents place a significantly greater educational value on outcome feedback than their program directors, and believe that follow-up should be a mandatory component of EM residencies.

Remember that patient you saw last week?

Patient outcome feedback has been defined as 'the natural process of finding out what happens to one's patients after their evaluation and treatment (in the ED)'. It seems likely that emergency medicine trainees and Fellows will improve their diagnostic accuracy if they increase the frequency with which they find out what happens to their patients. Not only does this allow testing of their own diagnosis with the final diagnosis, but also allows meaningful feedback on therapies commenced in the ED. We believe that seeking outcome feedback should be more actively encouraged by the ACEM training programme.