Depression, Anxiety, Energy, and Fatigue Among Nurses Who Cared for Patients During the COVID-19 Pandemic: A Cross-Sectional Study.

Purpose of Study: Nurses around the world have faced challenges during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the association between depression and anxiety and trait energy and trait fatigue, and baseline health status and work characteristics. Design of Study: A cross-sectional study. Methods: A survey was conducted to collect self-reported data from nurses involved in patient care in Northern Virginia. Depression and anxiety were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) depression and anxiety scales. To measure trait energy and trait fatigue, the Mental and Physical State and Trait Energy and Fatigue Scale (MPSTEFS) was used. Findings: There was a significant association between depression and energy (b=-0.46, t = -1.78, p < .001) and loneliness (b=1.38, t = 4.00, p < .001) and increased alcohol use (b=2.11, t = 2.04, p = .045). We also found that nurses with depression were significantly more likely to seek mental health counseling (b=-2.91, t = 2.54, p = 0.013), which was also the case for anxiety (b=3.13, t = 2.14, p = .036). Conclusions: Our study highlights the mental health burden among nurses who worked in the early phase of the COVID-19 pandemic and its association with increased alcohol use and loneliness. The findings may help healthcare leaders identify early signals of deterioration in nurses' well-being.

Correction to: Using a Nonconcurrent Multiple-Baseline Across-Participants Design to Examine the Effects of Individualized ACT at School.

[This corrects the article DOI: 10.1007/s40617-021-00558-8.].

Using a Nonconcurrent Multiple-Baseline Across-Participants Design to Examine the Effects of Individualized ACT at School.

The purpose of the current study was to examine the effectiveness of implementing acceptance and commitment therapy (ACT) with three students who displayed disruptive and off-task behaviors in a classroom. A nonconcurrent multiple-baseline across-participants design with an embedded reversal was used to compare the effects of individualized ACT exercises and treatment-control conditions on classroom behaviors that included on-task behavior, vocal disruption, physical aggression, and classroom disruption. Classroom behaviors were measured during 5-min direct observations using continuous 30-s interval recording. During baseline, all participants displayed low levels of on-task engagement and high or varying rates of challenging behaviors. When the individualized ACT intervention was implemented, participants' on-task and challenging behaviors improved compared to baseline and treatment-control conditions; treatment-control conditions produced mixed results. Implications for school-based treatment programs and collaborative transdisciplinary intervention strategies are discussed.

Protocol for the Mason: Health Starts Here prospective cohort study of young adult college students.

BACKGROUND: Young adulthood is a period of increasing independence for the 40% of young adults enrolled in U.S. colleges. Previous research indicates differences in how students' health behaviors develop and vary by gender, race, ethnicity, and socioeconomic status. George Mason University is a state institution that enrolls a highly diverse student population, making it an ideal setting to launch a longitudinal cohort study using multiple research methods to evaluate the effects of health behaviors on physical and psychological functioning, especially during the COVID-19 pandemic. RESULTS: Mason: Health Starts Here was developed as a longitudinal cohort study of successive waves of first year students that aims to improve understanding of the natural history and determinants of young adults' physical health, mental health, and their role in college completion. The study recruits first year students who are 18 to 24 years old and able to read and understand English. All incoming first year students are recruited through various methods to participate in a longitudinal cohort for 4 years. Data collection occurs in fall and spring semesters, with online surveys conducted in both semesters and in-person clinic visits conducted in the fall. Students receive physical examinations during clinic visits and provide biospecimens (blood and saliva). CONCLUSIONS: The study will produce new knowledge to help understand the development of health-related behaviors during young adulthood. A long-term goal of the cohort study is to support the design of effective, low-cost interventions to encourage young adults' consistent performance of healthful behaviors, improve their mental health, and improve academic performance.

Risky Business: Increasing Risky Betting Through Rule-Governed Behavior.

The present study replicated and extended previous research by exploring the extent to which rules altered participants' engagement in risky betting in an electronic blackjack game. A multiple-baseline across-participants design with predetermined phase changes was used to assess 4 recreational gamblers' betting patterns in blackjack across 3 phases. During baseline, participants played blackjack with no exposure to rules. In the faulty rules phase, researchers gave participants a rule that suggested larger payouts would occur if gamblers played let-it-ride bets. Let-it-ride bets were placed after a winning hand and required participants to wager their entire winnings on the next hand. During the correct rules phase, researchers gave participants a rule that suggested that the let-it-ride bets did not result in larger payouts. Data on let-it-ride bets across each minute of play were collected. The results of the study demonstrated that the frequency of risky bets increased when participants were exposed to the incorrect rule. Following participants' exposure to correct rules, risky bets decreased, but most participants did not return to baseline rates.

Preliminary Evidence on the Efficacy of Mindfulness Combined with Traditional Classroom Management Strategies.

The current case study combined mindfulness-based strategies with a classroom behavior management treatment package, to assist teachers with managing 3rd grade student behaviors. Two teachers (Classroom teacher and Specials teacher) and six students within the same classroom were observed using a 5-min momentary time sampling procedure. A delayed multiple baseline across settings (e.g., Classroom teacher, Specials teacher) design was used to assess student behaviors across baseline (A), classroom behavior management treatment package (CBM) (B), CBM plus mindfulness (C), and CBM plus mindfulness and self-monitoring (D). Behavioral treatment alone increased on-task behaviors for four of six (66%) students compared to baseline; however, five of six (83%) students increased and sustained high rates of on-task behaviors when mindfulness exercises were added to the behavior analytic techniques. These preliminary results support the combination of mindfulness-based strategies with traditional behavior analytic interventions for increasing student on-task behaviors in classroom settings.

Effects of Response Effort on Resurgence.

The present study examined response effort during resurgence tests. Six children were trained to place balls in baskets that were placed either close (.0254 m) or far away (1.829 m or .9 m). Resurgence was assessed using a linear strip design, where responses were reinforced on a variable-interval 10-s schedule or put on extinction. During resurgence tests, minimal to low rates of resurgence associated with the greater response effort (i.e., placing a ball in the basket further way) were observed across all six participants, regardless of distance.

Using a Progressive Ratio Schedule of Reinforcement as an Assessment Tool to Inform Treatment.

A handful of studies have examined the utility of progressive ratio schedules (PRs) of reinforcement in treatment development and treatment efficacy. The current case study explored the utility of PRs as an assessment tool to inform a differential reinforcement treatment package. A PRs assessment was used to identify the breaking point of a functional communicative response before and after treatment. The breaking point was used as the initial reinforcement schedule during treatment. Following treatment, the communicative response increased during a posttest PRs assessment, suggesting the efficacy of the treatment package.

Gambling prevalence rates among immigrants: a multigenerational examination.

INTRODUCTION: The present study employed data from Waves I and II of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) to compare gambling prevalence rates across gender and world regions (e.g., Africa, Asia, Europe, and Latin America). METHODS: Responses from first generation (n=5363), second generation (n=4826), third generation (n=4746), and native-born Americans (n=19,715) were subjected to a series of multinomial regression analyses, after controlling for sociodemographic variables such as age, gender, race/ethnicity, household income, education level, region of the United States, and urbanicity. RESULTS: The prevalence of gambling and problem gambling was markedly lower among first-generation immigrants than that of native-born Americans and second and third-generation immigrants. Results also point to inter- and intra-generational dynamics related to gender, age of arrival and duration in the United States, and world region from which participants emigrated. Additionally, we found that second-generation immigrants and nonimmigrants were significantly more likely to meet criteria for disordered gambling compared to first-generation immigrants in general. CONCLUSIONS: Compared to first-generation immigrants, male and female immigrants of subsequent generations and nonimmigrants were significantly more likely to report involvement in all problem gambling behaviors examined. Findings suggest that gambling prevalence rates increase across subsequent generations, and are more likely to occur in women than among men.

Implications of Derived Rule Following of Roulette Gambling for Clinical Practice.

Problem gambling is a global concern, and behavior analytic attention has increasingly focused on reasons for why problem gambling occurs and conditions under which it is maintained. However, limited knowledge currently exists on the process to which self-generated rules maintain gambling behaviors. Therefore, the current study assessed six recreational gamblers on a roulette game before and after discrimination training to establish a self-rule to wager on red or black. Following discrimination training, all six participants altered their response allocation among red or black and consistently responded according to the newly derived self-rule. Results maintained during 1-week follow-up sessions across all participants. Implications for clinical application of self-awareness and self-generated rule following are discussed. Implications for practice • Demonstration of how stimuli such as color can alter gambling behavior • Procedures to assist clients with changing self-rules about gambling behavior • Using self-generated rule formulation for more contextually appropriate target behaviors • Highlights how self-generated rules can be altered to change clinical target behaviors.

Exploring the Clinical Utility of a Stimulus Avoidance Assessment to Enhance a Relaxation Training Model.

The current case study explored the clinical utility of a stimulus avoidance assessment during relaxation training with an adult with an autism spectrum disorder. A multiple stimulus without replacement procedure was implemented with aversive events to identify an aversive situation hierarchy. Aversive events were then systematically presented during the analogue phase of relaxation training across low, medium, and highly aversive events. Results support a clinical utility of using stimulus assessments to inform relaxation training, while suggesting further modifications to relaxation training protocols for generalization of skills.

A Critique of Sociocultural Values in PBIS.

Horner and Sugai provide lessons learned from their work with disseminating the Positive Behavioral Interventions and Support (PBIS) model. While PBIS represents an empirical school-wide approach for maladaptive student behaviors, the model appears to have limitations regarding sociocultural values and behavioral data collection practices. The current paper provides an overview of three identified areas for improvement and outlines how administrators using PBIS can incorporate acceptance and mindfulness-based intervention procedures to address the discussed limitations.