Avoiding the Traps of Thought: The Relevance of Language and Rules for Acceptance and Commitment Therapy.

Behavioral therapy has greatly evolved and branched out in different directions since its inception. Three stages in the development of modern behavioral psychotherapies can be discerned: behaviorism, the cognitive revolution, and, most recently, the so-called third wave behavioral therapies. Characteristic of third-wave therapies is the great heterogeneity in treatment strategies. To gain a deeper understanding of several third-wave approaches, we here outline relational frame theory (RFT) as an important theoretical foundation. RFT explains how experiential avoidance, a behavioral strategy aimed at eschewing unpleasant internal experiences (e. g., thoughts, feelings, memories), promotes the onset and progression of psychopathology. Acceptance and commitment therapy (ACT), a prime example of a third-wave therapy, focuses on cultivating the skills needed to embrace discomforting thoughts and emotions. Accumulating evidence including meta-analytic evidence supports the effectiveness of ACT in a wide array of psychiatric disorders.

Improving training of laparoscopic tissue manipulation skills using various visual force feedback types.

BACKGROUND: Visual force feedback allows trainees to learn laparoscopic tissue manipulation skills. The aim of this experimental study was to find the most efficient visual force feedback method to acquire these skills. Retention and transfer validity to an untrained task were assessed. METHODS: Medical students without prior experience in laparoscopy were randomized in three groups: Constant Force Feedback (CFF) (N = 17), Bandwidth Force Feedback (BFF) (N = 16) and Fade-in Force Feedback (N = 18). All participants performed a pretest, training, post-test and follow-up test. The study involved two dissimilar tissue manipulation tasks, one for training and one to assess transferability. Participants performed six trials of the training task. A force platform was used to record several force parameters. RESULTS: A paired-sample t test showed overall lower force parameter outcomes in the post-test compared to the pretest (p < .001). A week later, the force parameter outcomes were still significantly lower than found in the pretest (p < .005). Participants also performed the transfer task in the post-test (p < .02) and follow-up (p < .05) test with lower force parameter outcomes compared to the pretest. A one-way MANOVA indicated that in the post-test the CFF group applied 50 % less Mean Absolute Nonzero Force (p = .005) than the BFF group. CONCLUSION: All visual force feedback methods showed to be effective in decreasing tissue manipulation force as no major differences were found between groups in the post and follow-up trials. The BFF method is preferred for it respects individual progress and minimizes distraction.

Increasing efficiency of surgical training: effects of spacing practice on skill acquisition and retention in laparoscopy training.

OBJECTIVES: The goal of this study was to investigate the effects of spaced versus massed practice on skill acquisition and retention in the context of laparoscopic motor skill training. BACKGROUND: Reaching proficiency in performing laparoscopic surgery involves extensive training to acquire the required motor skills. Conventionally, training of such skills occurs during a full day training event utilizing surgical simulators that train specific motor skills pertinent to laparoscopic surgery. An important variable to consider is the optimal schedule for laparoscopic motor training. METHODS: In this study, two groups of trainees without prior experience were trained on a variety of physical box-trainer tasks on different time-schedules. One group received three 75-min training sessions on a single day (massed condition) and the other received one 75-min training session per week for three consecutive weeks (spaced condition). Short- and long-term retention were assessed 2 weeks and 1 year after the completion of training. RESULTS: Outcome measures indicated better performance at the end of training, at a 2-week delayed retention session and at a 1-year retention session for the group that received training on a spaced schedule. This spacing effect was most pronounced for the more difficult laparoscopic training tasks such as intra-corporeal suturing. On average, 21 % of participants in the massed group and 65 % in the spaced group reached proficiency by the end of training. CONCLUSIONS: Spacing practice of laparoscopic motor skill training will facilitate skill acquisition, short-term and long-term retention, and thus, a more efficient learning process for trainees. Though more challenging in terms of logistics, training courses in medical centers should distribute practice sessions over longer time intervals.

Optimal training design for procedural motor skills: a review and application to laparoscopic surgery.

This literature review covers the choices to consider in training complex procedural, perceptual and motor skills. In particular, we focus on laparoscopic surgery. An overview is provided of important training factors modulating the acquisition, durability, transfer, and efficiency of trained skills. We summarize empirical studies and their theoretical background on the topic of training complex cognitive and motor skills that are pertinent to proficiency in laparoscopic surgery. The overview pertains to surgical simulation training for laparoscopy, but also to training in other demanding procedural and dexterous tasks, such as aviation, managing complex systems and sports. Evidence-based recommendations are provided for facilitating efficiency in laparoscopic motor skill training such as session spacing, adaptive training, task variability, part-task training, mental imagery and deliberate practice.

The Effects of Spacing, Naps, and Fatigue on the Acquisition and Retention of Laparoscopic Skills.

BACKGROUND: Earlier research has shown that laparoscopic skills are trained more efficiently on a spaced schedule compared to a massed schedule. The aim of the study was to estimate to what extent the spacing interval, naps, and fatigue influenced the effectiveness of spacing laparoscopy training. METHODS: Overall 4 groups of trainees (aged 17-41y; 72% female; Nmassed = 40; Nbreak = 35; Nbreak-nap = 37; Nspaced = 37) without prior experience were trained in 3 laparoscopic tasks using a physical box trainer with different scheduling interventions. The first (massed) group received three 100-minute training sessions consecutively on a single day. The second (break) group received the sessions interrupted with two 45-minute breaks. The third (break-nap) group had the same schedule as the second group, but had two 35-minute powernap intervals during the breaks. The fourth (spaced) group had the 3 sessions on 3 consecutive days. A retention session was organized approximately 3 months after training. RESULTS: The results showed an overall pattern of superior performance at the end of training and at retention for the spaced group, followed by the break-nap, break, and massed group, respectively. The spaced and break-nap group significantly outperformed the break and massed group, with effect sizes ranging from 0.20 to 0.37. CONCLUSIONS: Spacing laparoscopic training over 3 consecutive days or weeks is superior to massed training, even if the massed training contains breaks. Breaks with sleep opportunity (i.e., lying, inactive, and muted sensory input) enhance performance over training with regular breaks and traditional massed training.

Varied Practice in Laparoscopy Training: Beneficial Learning Stimulation or Cognitive Overload?

Determining the optimal design for surgical skills training is an ongoing research endeavor. In education literature, varied practice is listed as a positive intervention to improve acquisition of knowledge and motor skills. In the current study we tested the effectiveness of a varied practice intervention during laparoscopy training. Twenty-four trainees (control group) without prior experience received a 3 weeks laparoscopic skills training utilizing four basic and one advanced training task. Twenty-eight trainees (experimental group) received the same training with a random training task schedule, more frequent task switching and inverted viewing conditions on the four basic training tasks, but not the advanced task. Results showed inferior performance of the experimental group on the four basic laparoscopy tasks during training, at the end of training and at a 2 months retention session. We assume the inverted viewing conditions have led to the deterioration of learning in the experimental group because no significant differences were found between groups on the only task that had not been practiced under inverted viewing conditions; the advanced laparoscopic task. Potential moderating effects of inter-task similarity, task complexity, and trainee characteristics are discussed.

[Feedback during laparoscopic training]. / Feedback bij het aanleren van laparoscopie.

A recent Danish study showed that instructor feedback significantly reduced the duration of training time needed for acquiring laparoscopic skills. While there is a clear advantage to trainees reaching a predetermined expert level of performance more rapidly, this does not necessarily imply that the skills were also acquired more efficiently. Experiencing continual feedback while undergoing a training task could reduce the level of difficulty in performing it; the presence of an instructor can also heighten emotional tension. Both of these factors can impair the learning process. For this reason, we recommend self-directed feedback during training on complex laparoscopic skills.